HomeMy WebLinkAboutChange of Contractor it
PLANNING & DEVELOPMENT SE
BUILDING & ZONING DIVISION CEI
s 2300 VIRGINIA AVE
. JAN-7 2021
-' - - FORT PIERCE,FL 34982(772) 462-1553 FAX 462-1578 Permitting
artmentelm r County, FL
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
X 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-ottt). A recorded copy must be
submitted prior to commencing 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: 1-7-21 Permit Number: 2001-0557
Site Address: 9213 Potomac Dr, FT Pierce
Brian W Davidson State License CRC1327068 SLC License
Original GC,subcontractor or owner/builder
Steven R Young State License CBC1252212 SLC License
New GC,subcontractor
Reason for Cancellation New GC has the ability to pull commercial permits,old GC was only able to pull residential permits
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/sub c ractor or cellation of permit.A permit cannot be canoe tf work has een performed.
SIGNATURE OF OWNER(or owmer/builder) SIGNATU :GENERAL CON R new GC,as applicable)
PRINT..NAME,-Brian W Davidson PRINTNAME Steven-R Youfig
State of Florida,County of St Lucie County State qr Florida,County of St Lucie County,
The following instrument was acknowledged before me this The.following instrument was acknowledged belbre me this
day of January �0 2t b}, r day of_���dy Z0 21.by
Brian W avidson %vho is personally knon„t to me Steven R Young who is nersonallvknown to
'` io ras prgd c as ID.
1-7-21
Signature of Notary Date Signature of Not:1ry Date
r �rs'raro•.• DINAPARRINO
�, +�",f• ., `� ..s �` MY COMMISSION#GG 935643
EXPIRES:February27,2024
EXPIRES:February 27,2024 'FOF sti?eE Bonded Thru Notary Public Underwriters
'to'. Bonded 7tw Notary public UrIdetwrlters