HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 RECEIVED
(772) 462-1553 FAX 462-1578 1107 1010
Permittin D ent
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION (�tFi P]�
PLEASE SELECT 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
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: \, 2- / ( \ Z.,-2,,
Permit Number: %yis �- , 6
Site Address:—4 �/ .¢ t4 n fZ 7" ilJ�.c� v�e✓c� /
c ,�� . •,1/ State License SLC License
Original GC, subcontfactor or owner/builder
_ A%UT o k.?-, State License(2 L r 7.�;"�2LC License
New GC, subcontractor
Reason for Cancellation
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/subcontraoor or cancellation of permit. A permit cannot be cancelled if work has bee erformed.
, IGNATUiCb OF OWNS i owner/builder) SIG CTO or ne , applicable)
PRINT NAME !°�G7/IU `�' PRINTNAW
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
—a—day oft Q,C 20 d\6 by �4,6
t" q`•�--i"!A who is personally known to me
or who has produced. as ID.
Signature of Notary Date
Revised 04.15
DEAN4AMARIE GNENS
MY COMMISSION # GG 0220
:�.rx:,:
23 ;`
EXPIRES: December 16, 2020 ;
:; a item
Bonded Thru Notary Public Undenra "
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of W tr— 20� by U6- -�{'
4 T%iiwho is personally known to
me or who has Droduced—��` as ID.
MY COMMISSION # GG 022023
EXPIRES: December 16, 2020
Bonded ihru Notary Public Underwriter.