HomeMy WebLinkAboutChange of Contractor I
PLANNING & 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
i
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.
Date: L4 12T)7oZ-1 Permit Number: Ll OS - L)IS
Site Address: J IS9 S_Ir nne� FIB Yt- Pi-p-rc-e
191UXY1 _%'nn TnQ • State LicenseMDRO-n SLC License
Original GC, subcontractor or o er/builder
I
j C711Y\�I(1 D(F_UJ'S eJ UDO O inQ- State License�.�.I q'19L43 LC License
New GC,subcontractor
Reason for Cancellation IM `[b7U Alb Oro nLQA-f_ )()b
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
co `actor/subcontracto cancellation of permit.A permit cannot be cancelled if work ha en performed.
S)Z WXTI.IRE OF OWNER(or owner/builder)I SIGNATURE GENE CONTRACTOR(or new GC,as applicable)
PRINT NAMElU. lady t,�.�, �' 1M 5 PRINT NAME 9Cn0Qb&% �l1'Yr2r1C2
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
,Thee following instrument was acknowledged before me this The following instrument was acknowledged before me this
�-0 day of W� 20�,by�l�� "tmday of nriX 2021,by �►(\
18Y� 6CL(Xb%5 who is personally known tome 6 Y f%C_0C7_- who is personally know to
or who h produced as ID. me or who hK produced as ID.
y 2X Zoe. -�I zgizoz
Signature of Notary Date Signature of Notary Date
Y Pii`•: ANGIE PERDOMO ads®�''•. ANGIE PERDOMO
Revised 04/�5.a� e�^: ;ag �F� Notary Public State of Florid
Notary Public-State of Florida �;
Commission p HH 41988
9 e: Commission#HH 47988 '
=«0° My Comm,Expires Sep 29,2024 •.•orv�5, My Comm.Expires Sep 29,2024
oon Jed through National Notary Assn. Bonded through National Notary Assn.
I
PERMIT# ZI d�3 S ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
- - — - •- ~- BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
W-Y)b 1 r-O 4- DY0 i f-'*N have agreed to be
(Company Name/Individual Name)
the D I L.Lh(1 b x Sub-contractor for NoL ainos ftmn&S
(Type of Trade) (Primary Contractor)
For the project located at SP S -! LuD d st. , F-76Y+ P i-cy
(Project Street Address or operty Tax ID#
It is understood that, if there is any change of status regarding our participation with the above mentioned
project,the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
CONTRACTOR SIGNATURR►E(Qualifier) [ SUB
-COONTRACTO ATURE(Qualifier)
PRINT N ' ' PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of r5•1 UIL h State of Florida,County of51 •l UGi e
The foregoing instrument was signed before me this DO day of The foregoing instrument was signed before me this 2t fd y of
v zo21 by yykC Fx. QJn Wd Wf1^ (� lr"1 ,2021,by X1J0.1Wyr\ 'S i t;rerlP�
who is personally known zor has produced a who is personally known_or has produced a
as identification. as identification. ��;Y•o�..: ANGIE PERDOMO
4�N� Notary Public State of FTAssn.
STAMP '� Commissi0gtX*J,79
Signature of Notary Public Signature of Notary Public ?F F••` my—Comm.Expires Sep 29
Bonded through National Notar
Vexanly-10 Ark( ; -e f fAci ko
Print Nam elf Notary ublic Print Nanii of Notary Public
� Ypue�; ANGIEPERDOMO
?°• \a� Notary Public-State of Florida
y
I e; Commission#HH 47988
" ovo?r My Comm.Expires Sep 29,2024
Revised 11/16/2016 Bonded through National Notary Assn.