HomeMy WebLinkAboutChange of Contractor � PLANNING & DEVELOPMENT SE EIVED
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
. FORT PIERCE, FL 34982 LittingDepartment
V1
(772) 462-1553 FAX 462-1578 7Perm
, 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.
w' ;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: 9 C)— C
Site Address: �o
maa bLl Lmwl I State License It 9SLC License
Original GC, subcontractor or owner/builder
State License SLC License
New GC,subcontractor or owner/builder
i
Reason for Cancellation Ru 11"ll .
The undersigned does hereby agree to indemnify and hold harmless St Lucie Co ty, 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, e ca 1 ed if work has hee or
SIGNATURE OF OWNER(or ownerlbuilder) =)TN.AM
RE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME Pa � ��
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following' met was aclledged efore me this
day of ,20_�by '—day of 209 by�i1Q1)
who is personally km o e � �� who is pe nally kno to
or who has produced as ID. a or o h oduced as ID. t,e,
.��• �?.^ill
Signature of Notary Date ` •'� %�, Myl'u na Date
�c ,,o Y ConUr C0171 sfxn es qua��lorida
Revised 05/18/2017 on �fF1?9097�18
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