HomeMy WebLinkAboutChange of ContractorC
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PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300. VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLFASE SE E T ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR— Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
co Wing any work There is a $50.00 fee for the Change of Contractor.
� CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: L te Z,(p 11 Permit Number: �l c7 `?=+
Site Address: T ® �l�� t� �1�1�� popzr �f - LC c }"� ,
O 9°
c I� ` C !4 l C.,J I'll / 0'x � State License L 1.1 S
� � s� SLC License
Original GC, sdbeont actor or owner/builder
C' o 0 I ('I,, 1 "` State License LAL SLC License
New GC, subcQatmctor
Reason for Cancellation I S S v3�e.
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees es arising from any and all claims of action for any reaso hich ma se as a result of this change of
con o u ctor or cancellation of permit. A permit a be cane ll o s been performed.
SIGNA /Ac- (or owner/builder)
.—� SIGNATURE G (� CO, . CTOR (or new GC, as applicable)
PRINT NAME V fG' 4. ` � fs&RL�KGze'+z= PRINT NAME ' A) _C Q
State of Florida, County of St. Lucie County
The
� following instrument was aclotowledged before me this
r 0r day of V ]e— 20j_L by
l J CV is personally Imown to me
or who has produced as ID.
signature of Notary Date
Revised 04/15/16
MYCOMM1SSIOP411tFFene
EV1RES VkMb2%=0
., , .�`
Bond1d11w Natty Pu41leU�x�Stus
State of Florida, County of St Lucie County
following ins�t w,� en�t wo as ac ledgOld �� ,,0
this
day of 20by 1� s
0 who is pally knnWL to
me riP has produced as ID.
AA- 1TA 0J,—
d
ignatare of Notary bate
,;;�►" %y% DENISE SARDEEN
Commission N dG 6237
My Commission Ex Tres
3r^M1 June 27, 2020..
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xY
PERMIT# :?LanISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
(Company NameQndividual Name)
the [A Vfl C_ Sub -contractor for
(Type ofTrade) (Primary Contractor)
For the project located at 1 370 51gKWca 36 ve Ase i ST. L uar= F- s4 qsy-'7
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St, Lucie County will be advised pursuant to the
Ming of a C of Sub -contractor notice.
CONTRACTOR (Qualifier}
�P Lz 0qPERC-ice
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of Elm a
The foregoing instrument was signedImfore me this� . delay of
AMC,
��
who is peisomilty Imown ) or has produced a ���
as identification.
hm A F'. 11�
Sig of otariPnbfic
Womb ryyV\1 Ca%
Print Name of Notary Public
COUNTY CERTIFICATION NUMBER
State of Florida, County of h— Q
day of
The foregoing instrument was signed before me this
pp e
,2oAby _S.C- 1 4���,��5
who is personally !mown � ' has produced a D
as id�tlfication.
STAMP STAMP
Signature of Notary Pub
0
WinfName olvietury Public
„� w�at�ABaw�cic
'
WCOM M-W
FJ pk-NC1md a2m
Revised 11/10016
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isw"71 NNattNA"th xe
a:►"':'''•, DENISE BARDEEN.
* Commission"N GG"6237
My Commission Expires
June 27, 2020