HomeMy WebLinkAboutChange of Contractor - -
FRECEIVED
Planning& Development Services
Building & Code Regulations Division 5 2018
• 2300 Virginia Ave.s . Fort Pierce,FL 34982 ty, Permitting
" (772)462-1553 Fax 462-1578 —J
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 Sub-Contractor 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: Z • z7 Permit Number 70 OZAI2-,
Si Address: -1,2 �OR-�S�aC.t. JJI�
AL
nin A DAV tate License /-24UYSLC License
At
igmal GC, subco tractor or owner/bbUilder
W U ems. %! D /S State License C13e/,U-1129 SLC 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/subcontractor oi-cancellation of
pe•rnit A permit a cancelled if work has been ormed.
6L
GN TURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONT�RA(CTOR(or new GC,as\applicable)
�
PRINT NAME Z_/SA FE L O PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St. Lucie County
The following instrument was acknowledged .before me this 'I'he following instrument was acknowledgeed�before me��►'t w
day of � 6 .20 l t.by /G5� ���� a-7 day of�,20/8,by 61f�
who is personally know to me who is personally 6 o to me
or who as produced as III or who o s pr duced as I
Signattl'rtmf Notary Date Signature of Notary Date
1vs y pus RHONDA S ROWE aaRY Pie RHONDAS ROWE
* t Comml'sslon#GG 104656 * * Commrssion.#GG 104656
Revised 04/1,� ' Expires May 19,2021 N, oe Expires May 19,2021
9-pp p�oQ� Bonded Thru Budget Notary Services 9rFOF F���\ Bonded Thru Budget Notary SeiiYke,
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