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HomeMy WebLinkAboutChange of ContractorLANNING &DEVELOPMENT SERVICE BUIIrDING &ZONING DIVISION 17 2300 VIRGINIA AVE FORT PIERCE; FL 34982 (772) .462-1553 FAX 462-1578 JUN 12 201 PERIMI1171NQ St. Lucie County, FL 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 signed by the general contractor only. The new subcontractor must fill out a Subcontractor Agreement Form which is signed by both the contractor and subcontractor. 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: Permit Number: 1 n - c L Site Address:. 153 J � f oin 6i1 V t�f V`2 �ri' kl - State License SLC License _ rigmal GC subcontractor or owner uilder GO State License 1C ls0 SLC License New GC, subcontractor or owner uilder Reason for Cancellation Tile undersigned does hereby agree to indemnify and hold harmless St Lucie costs, fees or damages arising from any and all claims of action for any reKo contractor/subcontractor:or cancellation of permit. A permit cannot be Banc Z 4_�� Imo` S ATURE OF'OwNER (or owner/builder) %% •SIGNATURE d PRINT NAME��j^l/1O �,°t PRINTNAMEF State of Florida, County of St. Lucie County officers, agents and employees from all ry arise q a result of this, change of MMZ7d.� (or new G9, as State of Florida, County of St. Lucie County The following ' eat was acknowledged before me this Thefqllowig instrument was ac ledg before me thi day of. 2011 byL� e�Ko(iS �Y of y 20 by� fl�� who is personally known to me c who is personally known to or who has producedLL L as ID. me or who asp r3uled as ID. Signature of Notary Date Signature of Notary Date E KAREN S. :FF LSENPAMELACORTESot•CommissionS b5537Revised 05/18/2017 :2,�i`S:: NotaryPubllr-State of Florida *;CoyPublionkG6080lorida+My Commissixpires' 0My Comm. Expires Apr30,2021 iUnB 121'8 OPF °e' Bonded through National NotaryAssn. • 0 PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION o 2300 VIRGINIA AVE FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 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: ©3— Z 7 — gw/d' Permit Number: 1703 " O 51f / Site Address: 1 S3,S-51 N,4111,9 1 D%/!_E AJie J%�WO 7- State License GACfcPlVIVaSLC License ZS'_j63 Original GC, subcontractor or owner/builder X.4z- Afire State License eCO ,SB467.SSLC License New GC, subcontractor Reason for Cancellation 7P 1-4S9- /%/1r-4tA#7_ t-fad 4�V7Xd, - 7-0,4-- 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 contragtor/subcontractor or cancellation of permit. A permit cannot be ne ed j f^*rk has been performed. SIG14ATVRE OF OWNER�br i�,23e owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable) PRINT NAME ZA;;;,il�s PRINT NAME_ D�'r/ (�Q(47%%zp State of Florida, County of St. Lucie County The following instnunent was acknowledged before me this -!!day of itf H , 20A, by kMYASIVW who is personally known to me i- orwho has >r, d as ID. &)re of Notary Date Ryan Seals Slattery NOTARY PUBLIC Revised 04/15/16 STATE OF FLORIDA 01"Comm# FF194445 Expires 1/29/2019 State of Florida, County of St. Lucie County The following ins ,�,ent was aclmgwledged before me this day of M*K14 20 0 by 6"We &a*154dwho is personal1 wn to me or who has rod r ed as ID. 3 z� is Si to of Notary Date t Ryan Sean Slattery NOTARY PUBLIC STATE OF FLORIDA e= Comm# FF194445 Expires 1/29/2019 PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BIJTI.D.I.NG PERMIT SUB -CONTRACTOR AGRI?TEMENT r / �7F�L _ �} 14 -,� 11C • have agreed to be (Company Nameitnd'vJ ital Name) the ............._.__._ � .._.... _-.._....._........._...................__.......- —... Sub -contractor for - .....G (Type of Trade) (Primary Contractor) For the project located at. ,�%T��1/S' /�rj � Al/gL/D/Il r�� -.. -- _......._._.... (Project Street Address or.Property Tax ID 4) 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 filing of a Change of Sub -contractor notice. CO`,RACTOR SIGNATURE (Qualifier) PRINT N4YE 1"'wC/50'a? p / 3 o/ po COUNTY CI?RTIFICATION : IJIMBF.R State of Florida, County of The foregoing instrument was signed before me this vy of A ff 2& by G'iP. /„Ofl1 �1y0 who is personally known or has produced a as identirication. _ 3/27 �t% STAMP Silktatur vF Notary Public �W 5t.017vIw Print Name of Notary Public Ryan Sean Slattery NOTARY PUBLIC 'STATE OF FLORIDA Comm# FF194445 6 te'►� Expires 1/29/2019 Revised 11116,12016 G _........-....__.........._......................... _..... _.. -- SUB-C 7Rr TOR SIGNATLIRI (Qualifier) PRINNT NANIE r$;1?J01/ COUNTY CERTIFICATION NU iBER State of Florida, County of 5T Lu cK The foregoing instrument was signed before me this 6 day of rn� 20aby PQdJfa(& w s persona _ nutvn _or has produced a STAMP NORMAJ.STACK -i MY COMMISSION # GG 060347 IF P� EXPIRES; Ma 5 2021 60nded Thnt Notary Pubric Unde-Wdtcrs