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HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES II BUII.DING & ZONING DIVISION COUNTY2300 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: GE 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: -3 Permit Number: 10 1 — © Z Z Site Address: ?,Q C7 p C � G ,5 rP_v C 7z-11Z,R— e a9li l State License O GGo 33 SLC License Original GC,subcontractor or owner/builder X Q� y• State License SLC License OT1 New GC,subcontractor Reason for Cancellation /V c-9 T"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 Cann rfor SIGNATURE OF WNER Cor owner/builder) SIGNATURE GENE&CO (� TOR(or kw as, applicable) PRINT NAME yno- " PRINT NAME si_S T • \���7 State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County The following instrument was acknowledged before me this T�]]e4llowing ent as aclno lodged before a this tt�day of 20_1 by (.A,,day of ( 20�by t e- who is personally known to me who isc�ors all known to or ho has produced as 1D me or odu 3 ( �I - 2 Signature of Notary Date Signature of Notary Date dbmdbA— Apo'•. DEBORAHGROMOVSKY ^, �,PU Revised 09/15/16 `. Notary Public•State of Florida ;r`� E;; ERICKDELGADO Commission N GG 235740 .�. Notary Public-State of Florida My Comm.Expires Jul 8,2022 Commission#GG 108222 Bonded through National Notary Assn. ' 'oFz My Comm.Expires May24,202i