HomeMy WebLinkAboutChange of Contractor Form_000059PLANNING & DEVELOPMENT SERVICES
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:
x 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:
Site Address: 2307 S 39th St. Fort Pierce FL
Code Red Roofers Inc.
Permit Number: SLC-2010-0073
State License
SLC License 23041
Original GC, subcontractor or owner/builder
Solis Roofing Contractors, Inc. State License CCC1330147 SLC License
New GC, subcontractor
Reason for Cancellation Code red roofers abandoned the work
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
contrai�qr/subcontractor or cancellation of permit. A permit cannot a cancelled if work has been performed.
SIGN URE OF OWNE9 (or owner�builder) SIGNAT RE,� CONTRA (or neeww GC, as applicable)
PRINT NAME LDd - 'J` o PRINT ME n� — t� ter, Jo (S
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following i trument was acknowledgeA before me this
day o�f� i < < , 20�, by t—DAU CL �t�
Oa r who is personally known to me ,
o has produ ed�„as ID
T�O��oZf
Signature of Notary Date
Revised 04/15/16
Th lowing instrumeLit, was acknowledged before me this
day of 20�by
w o is personally known to 1
m or who has produced as ID.
Q
Signature of Notary Date