HomeMy WebLinkAboutChange of Contractor (2) PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
• 2300 VIRGINIA AVE
- 3 FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEAS 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.
Date: d Permit Number: - O2
Site Address:
(/ Lnn� S License SLC License
Original GC,subcontractor or owner/builde , aq
\Jp 'A/' % a M M p/- �/�ff0sState License 6,6L4 i292SLC License
New GC,subcontractor
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 cancellation of permit.A permit cannot a cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME PRINT NAME
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 A5s—day of';Ar- ,2%A-by µ%�%-S
who is personally known to me who is personally known to
or who has produced as ID. me or who has produced f ii fl - as ID.
Signature of Notary Date Signature of Notary Date
:oiiRY°o DEANNA GIVENS
?; en. Notary Public-State of Florida
Revised 04/15/16 �� Commission;HH086359
of r� My Comm.Expires Jan 28,2025
Bonded through National Notary Assn.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��o a Permit Number: 2JO2---024
0
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
P ®P3Slx> vf�lti=fed`
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Address: �j �, e'te
Property Tax ID #: a Gp 1 — Lot No._!
Site Plan Name: Block No.
Project Name:
0 p��;.�V@sr..Jti1:LCI�t,JS �lvi'Tt\Jl�t' 1'
CANA
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas'Piping _Shutters' _Windows/Doors
_Electric _Pl'urribing ^Sprinklers _Generator _.Roof.• Pitch
Total Sq. Ft of Construction: 2 2U 0 Sq. Ft. of First Floor:
Cost
ppoff��Construction: $ Utilities: —Sewer
—Septic Building Height:
_�..t.. OEM
a-�.F� .� x
Name a Name: c�`,
Address: - -
Cc Company: eo
City: a, .' ,:= >C:,' ,,it ,State: Address: `.
T:'i fr J -
Zip Code: 3�.�1�" F,ax i;,` City:' �, or �2 Stater
Phone No. r� 4
! Zip"Code Fax:
E-Mail: Phone N
Fill in fee simple Tit(7Holder on next page(if different E-Mail
from the Owner listed above) State or County License_
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.