HomeMy WebLinkAboutChange of Contractor (2) 0 0
PLANNING & DEVELOPMENT SERVICES
COUNTY 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 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.
CANCELLATION OF PERNUT-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: S - /1 - I SS Permit Number: 1-7 1 d ^ O 0.1 7
Site Address: "-d 103 J NP.*RA)�f R k oot M Y^ O yeci r 3 ggYa
Tim C�t a sI&-f State License SLC License
Original GC, subcontractor or owner/builder
uCr(
Jt;"fif 8r_g0Z�SiU t Mg' FI��'�G State License SLC License ( 7 3
New GC,subcontractor or owner/builder
Reason for Cancellation Sb y[-"foil uW c>•r c)fj rju1ZA Cj-o 2 1f',4f 0"-L12-
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 cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or ownerlbuilder) SIGKATTME GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME PRINTNAME J1'F 8120D21►--6K4
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 instrument was acknowledged before me this
day of 20_,by �daY of 20�by
who is personally known to me is personally mown to
or who has produced as ID. m r who has produced imho
1"It as ID.
e m�
Signature of Notary Date Signature of Notary Date`
O�PRYPv�l��i LAST IiNA INGRAM
+,�.,ri� � Notary Public-State of Florida
Revised 05/18/2017 �� ; `o aQ Icy Comm. C:;pires Cec 20, 7
L4
.�� 177:� I