HomeMy WebLinkAboutChange of Contractor Aug. 2. 2018 10: 59AM No. 2667" LK 2
PLANNING & DEVELOPMENT SERVICES
T• BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
]FORT PIERCE,FL 34982 AUG 0 2 2018
(772) 462-1553 FAX 462-1578
ST. Lucie County, Porfnitung
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE S)?LET ONE OF THE 1-OLLOW.ING:
CHANCE OF CONTRACTOR--Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current pera t.A new permit application must also be completed with new
contractor information and signature. A new Notice of Cormnencement must be filed in the new contractor's.tiame
fox job 'values greater than $2,500 (S7,500 if A/C Change-out). A recorded copy must.be submitted prior to
coimaencing any work.There is a 550.00 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 t4 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.
Bate,, Z 1 Perm- it Number: n
Site Address: I� UCCA Div ,, �Fm 'Rerce, L
1 CM
tsi
4i 0 0 State LicenseCCC 13299TS�_4 SLC License e
Original GC, bcontiacto or owner/builder
Coll ,99
�•na-?_ 2160 i State License SLC License %12
New GCQ_�bconI for
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 claim faction for any reason,which may arise as a result of this change of
contractor/subconiracror or cancellation of p A permit cannot be cancelled if work hag been performed.
SIGNATURE OF OWN)~R(or owne/r//build_e�r) SIGNATURE GENJERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME jyY1 l9LRiJt� PRINTNAMR
Srate of noiida,County of Sr,Lucie Coonty state of Florida,County of Sr.zucio County
The following instrument was aeknowledbcd before me this The following instrument was acknowledged before nie tWs
day of! uQ/ 20 ,by D A day of,-,_, ,20_,by
who is e8=Uy-kaown to \vho is personally known to
o ¢ pr ' �a me or who has produced as M.
Signature of Notur3' JI DAce Signature of Notary rare
Paula El.O'Brien
Revised 04/15/16 NOTARY PUBLIC
STATE pF FLORIDA
Contra#FF970337
Expires 3I14/2020
I