HomeMy WebLinkAboutChange of Contractor Form, 2.22.21PLANNING & DEVELOPMENT SERVICES
- ' ' - BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SFI.FCT 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.
"Z"=""" CANCELLATION OF PERMT — 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: 02/03/2021
Site Address: 12772 NW Mariner Court, Palm City, FL 34990
Permit Number: 2010-0761
Masterpiece Builders State License CGC 048543 SLC License
Original GC, subcontractor or owner/builder
State License '1//,'Z SLC License
New GC, subcontractor I f
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 or cane hf n f pe it. A permit cannot be ca celled if wort: has been performed.
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SIGNATURE O tv((N> R (Ar owns ttilaery % h� �� L� L , SIGN c L CONTRACTOR (or new GC, as applicable)
PRINT NAME i i3� %j� j�j ` pRI NAMG Je ery Bowers
State of Florida, County of St. Lucie County �Ldv� Statc of Florida, County of 5t. Lucie County
,Ile following instrument was acknowledged before me this
��day of February 203% , by �v, �,� �� • C'�,1�
who is personally known tome
off who h produ a _ as ID,
r t 0 /03/2021
Signature .f N �nry Dnte
The following instrument was acknowledged before me this
.!!—day of ..a., 2021 ,by !f!—
who 's personally know o
me or h, produced as ID,
02/03/2021
Signature of Nota Date
Revised 04/15 :i'•., SHIRLEYASAUNIER " CYNTHIAD.•IUNING
'�, MY COMMISSION N GG 367784
.; MY COMMISSION p HH 049290 +?
14A EXPIRES: January 31, 2025 EXPIRES: September 23, 2023
• ; eonded mN Notary Punr.c uadotwriters Bonded Tluu Notary RNIC Und"Ittsts