HomeMy WebLinkAboutChange of Sub-Contractor PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
L4 Cal k MR 2300 VIRGINIA AVE
i FORT PIERCE, FL 34982 MAR 1 2011
(772) 462-1553 FAX 462-1578 Permlttir.g Department
St. Lucie Courrh!
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 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.
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.
s
Date: 0.3 i (1,0 Permit Number: C)CILI 0Li 9 =-
Site Address: �I 1 �t v.�.�AzcCi +Ce �� —:s,1 ci �
5; LL C State License 024 3 LC License
Original GC,subcontractor or owner/builder
?W t Yn%(Y `I NO &Yrl L►'%-/+c; State License C' 2 B��r'�SLC License
New GC,subcontractor
Reason for Cancellation �t ti- C lfi i fig�i
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/subcontract or cancellation of rmit.A permit cannot be c ncelled if work has een performed.
5
SI NATURE OF OWNER(or owner/builder) ItNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME !j�-()it' K> r1J4 /-6014 Vi10 PRINTNAME /4�r'��`�y ��/
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following in in= t acknowledged before me this T�ollowing i en aclmo ledged before me this
day of�,20�,by 1' --day of 20�by
o is personally known to me �(1ti°y� Y Y�U��who is personally known to
for wfho has roduc as ID. me or who as pr ice \ I as ID.
YLA
Signature of Notary Date Signature of Notary Date
KAREN S. NIELSEN KAREN S. NIELSEN
`l�YW-W
PUB tpRY PUB
o %'- State of Florida-Notary Public ;=o ��c State of Florida-Notary Public
Revised 04/15/1 3a �' - ,
_. �= Commission # GG 207484 =* = Commission # GG 207484
%9� oP My Commission Expires
Ivry Commission Expires oFf`
June 12, 2022 �hmid• June 12, 2022