HomeMy WebLinkAboutChange of Contractor PLANNING G & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
- 2300 VIRGINIA AVE
qfl • e
MR
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 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 PERNHT—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:Z0Z 1 Permit Number: &Z_ )'A
Site Address: J�� .j l�l- -- - a Fb V`- Pir—r --e
�
nn.1rAtnn1& aw PI State LicenseMD1g09-1 SLC License
Original GC, subcontractor or o er/builder
�1JCknri 1 DZ W t.5 ftxnb inG State License C-,,.1 t4Z9 L1548LC License
New GC,subcontractor
Reason for Cancellation \Vk u +r' l
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 tractor/subcontractor or cancellation of permit.A permit cannot be cancelled if work ha en performed.
SIGNATUR r owner E OF OWNER(o builder) SIGNATURE G NE CONTRACTOR(or new GC,as applicable)
PRINT NAME, PRINT NAME Q0,.VX;n 2 ff r fn�Z
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 lowing instrument was acknowledged before me this
2 day of 121%P1 'Z I ,201L,b Z . day of Noir C I 20-,by ]�LVN
*(71S who is personal_ l=n to me who is personally know to
or who has produced as ID. me or who hn produced as ID.
LT ILs 12-1 1"7-WI-.02-t.
x
Signature of Notary Date Signature of Notary Date
Revised 04/15/�6:;i►3tY0�'•. ANGIE PERDOMO �QaaYPd"••, ANGIE PE
t�• Notary Public StFlorida
Notary Public-State of Flor da i. .
?. `pi..Q Commission#HH 47988 ®`; Commission u
'?u ' My Comm.Expires Sep 29,2024 spvv My Comm.Expire
Bonded through National Notary Assn. "Bonded through Nation
s ,
PERMIT# 2 ISSUE DATE
r, PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
have agreed to be
(Company Name/Individual Name)
the L-Lhn r, ex Sub-contractor for 14OWLAnns
(Type of Trade) (Primary Contractor)
For the project located at s?J�3 S
(Project Street Address or perty 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 SIGNATURE(Qualifier) SUB-CONTRACTO ATURE(Qualifier)
Jerf1 +t�K �
PRINT N PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of J '.fr'e. State of Florida,County of 51 .UWA4,
The foregoing instrument was signed before me this Z6 " day of The foregoing instrument was signed before me this 2VIE-y of
ao21 by Vyayne- brhn prnnS tr i 1 ,ao�M,by FLPX1.)fl l�eenP�
who Is personally known Af o has produced a who is personally known_or has produced a
as identification. as Identification.
� rAu"•; ANGIEPEROOMO
c`0�'P,'4; ANGIE PEROOMO Notary Public•State of Flori a
Notary Public-S �(,�lorida ?i Commissiog¢'JdNlf7988
Signature of Notary Public + mission H4 88 .•„F y amm.Ex ires,Se 29 2024
g y '?oF ` M Comm.Expires Se 29,2024 Signature of Notary Public P P ,
Y P Bonded through National Notary Assn.
Bonded through National Notary Assn.
Print Nam&bf Notary Public Print Nanit of Notary Public
Revised 1111612016