HomeMy WebLinkAboutSubcontractor Agreement r PLANNING & DEVELOPMENT SERVICES '
BUILDING & ZONING DIVISION
® 2300 VIRGINIA AVE
s t
- FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT'
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: 2:1 12.0 19 Permit Number:
Site Address: � 5 � Q—�-)
t h f-i 16\S State License Q j_ ; ilySLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor,
Reason'for Cancellation 4 l� �� �c`� + )rIZ9_11N
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 hich may arise as a result of this change of
contractor/subcontractor or cancellation of permit.A permit,cannot be cane ed if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE NT R or new GC,as app ble)
PRINT NAME PRINTNAME 1
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this Way
r ent was acknowledged before me this
day of 20_,by oday of ,20 by
who is personally known to me who is personally known to
or who has produced as ID. o as produced as ID.
Signature of Notary Date nature of Notary Date
Revised 04/15/16 r �
LASHAHNAINGRAWRAHMING
*: ._ MY COMMISSION#GG 275060
EXPIRES:December'20,2022I
Bonded Thru Notary public Underwriters
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