HomeMy WebLinkAboutChange of Contractor _ PLANNING &.DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
• r 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUHCONTR CTOR OR CANCELLATION OF PERM'►_
4andt
SELE ". ONF,f TI11 (]WIN .
CHANGE OF CONTRACTOR—Change of Contractor is to be signed find notarized by the property owner,
new contractor of record for the current permit, A new permit application must also be completed u h new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor' name
for job values greater than $2,500 ($7,500 if A/C Changc-out).' A recorded copy must be submitted i dor 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 cot tractor.
The new subcontractor must fill out a Subcontractor Agreement Form.There is a$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a pennit is acceptable only if no work has bec-i done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is-no fee for
cancellation of the permit
Date: Permit Number:"
Site Address: ._
Statc License S[-C License
Original CiC,subcontract r or owner/builder
State Licenses C �Licenwc _ • _
New GC,subcontractor�f
Rcasott for Cznlccllaticm _ — -
The undeNigned does hereby agree tq indemnify and hold harmless St Lucie County,its officers,agents and employees fr •m all
costs,fees or damages icing from any and all claims of action for any reason,which may arise as a result of this Change, I
contractor/s ra or canoe lino rmii,A permit cannot be cancelle as
SIG _TURE( ut R(or owiler/bailderl v SIGNATURE GE C'O�RACTORA(or new GC�le)
PRINT NAME Z.e-00- -ke! PRiNTNAMf
.State of Florida,County of Ft.Lucie County State of C•lorida.County of St.Lucie County
The following;instnimenl was acknowledged twifore mu thi% The 1ibllnwing inap't�lfJ ment waq acknowledged before me this
who inalL�kn tv the Yll � �_who is personally Itnuwn w
or vho has produced as fi, m or who has produced ac 1D.
1 1} a1— 21 1.11P7bl',.._ -tX.we t►i z i 2c� ;�
ignature of Notary Date %biaisty of Notary Date
r t Notary public sigte of Fhxidil
��►!a Notary Fubiip State W FlOr dp �,y
Nuv�t+��� pSL1 5 7 iY Christine HOIIArM y ' My QonlChristinR1N11011®$Z87t}1
Explret�04/Y217pP3
* my Commission or,szera '4j,V Empires 00912023
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicak]e7
Name:._ Name:
Address: Address:
State; City: State:_
City: Phone:
Zip-_ —Phone Zip'--FEE SIMPLE TITLEHOLDER: NotApplicable BONDING COMPANY: —Not Applicab
Name: Name:
Address: Address:
City: City: —
Zip: --Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application Is hereby made to obtain a permit to do the work and installation as in :hated.
I certify that no work or installation has commenced prior to the issuance of a permit.
5t.Lucie County
l makes no representation that is granting a permit will authorize the permit holder to build the subject strut )re
structure.Pleasecconlsult any applicable
ownn Owners o Association
iandrrev ew your de d or any restr ctions which maor
apply, such
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and 5t.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review;room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result In paying twice for
improvements to your property.A Notice of Commencement must,be recorded in the public record; of St.
Lucie County and osted on the jobsite before the first inspection. if you intend to obtain financing, onsult
with I n a me before commencing work or recording you cement. -
Signature of Owner/Lessee/Contractor as Agent for Owner Signat o Coutr c or License Holder
STATE OF FLORIDA . - STATE OF FLORID
COUNTY OF m Ai n� I_L1�5�� COUNTY OF a_+fly LU L t G _—
SwcJn to(or affirmed)and subscribed before me of swop to(or affirmed)and subscribed before me of
y Physical Presence Qr Online Notarization Physical Presence or Online Notarization
this day of ND 2020 by this Aq2�day of IJ ,2020 by
Name of person making statement. Name of person making statement.
Personally Known—&—OR Produced Identification Personally Known-- _OR Produced Identification_
Type of Identification Type of Identification
P oduced Produced
5ignature of Notary Public-5 t f ids riatine Holland J(Sature of Notary blic-State oNotary aiiblic state o Fb1 O , •, My commipion GG 3267 Christine Houantl
Commission No. a� ( jaso./2212023 mission No.(z(, la-1Cy IE Pire:air17I=
• i,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGFOVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIE-At
DATE
RECEIVED
DATE
COMPLETED
ev.