HomeMy WebLinkAboutChange of Contractor PLANNING& DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
40UNTY 2300 VIRGINIA\ AVE
4f D
FOIST PIERCE, FIB 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 pen-nit 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: L 2g �Z oZ i Permit Number:21_0 2 S .
Site Address: ��� ----------�--—_----- - b 1l Pi�P(�PP
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Ihi n&a-q pl1amb;m -ZnC . State LicenseMDIR0'7_7 SLC License
Original GC,subcontractor or o er/builder
a�,-n Ne yi'_% Auw inrA State License.C,P0,1 qZ9(4S LC License
New GC,subcontractor
Reason for Cancellation W � l,Q �IYI�Ql Jab
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 o�llation of permit.A permit cannot be cancelled if work ha en performed.
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SIG OWNER(oY owner/builder) SIGNATURE G NE CONTRACTOR(or new GC,as applicable)
PRINT NAME��vl, d rc '04cle-kA-, 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 lowmg;in trument was acknowledged before me this
2 day of Y Z ,20�� ,by�y 4C. _day of ins
LI 20—,by ht' W\
who is personally known to me who is personally known to
or wh has produced as ID. me or who h produced as ID.
Signature of Notary Date Signature of Notary Date
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Y u' ANGIE PERDOMO a►�Y"a� ANGIE PERDOMO
Revised 09 eG° (!po Notary Public State of Florida
Notary Public State of Florf
A c` Commission p HH 47988 ` Commission A HH 47988
®,t
My Comm.Expires Sep 29,2024 orvti My Comm.Expires Sep 29,2024
Bonded through National Notary Assn. Bonded through National Notary Assn.
PERMIT# 2 I o2-. O l? �- ISSUE DATE
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PLANNING & DEVELOPMENT SERVICES
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Building & Code Compliance Division
i:NCr R I s
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
P l w-yl d rl61 4- by-curl have agreed to be
(Company Name/Individual Name)
the ((url Sub-contractor for h-rgon-c"z'
(Type of Trade) (Primary Contractor)
For the project located at S� m 61d. ®Zr�t P i-e1(�
(Project SeetAddress MrpeDry 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)
l;? � Jerf1 �iti1r
PRINT N PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of Sat• _L GYe State of Florida,County of c�� •L ('��
The foregoing Instrument was signed before me thisAy—day of The foregoing instrument was signed before me thisPday of
Y I 201J,by Mnf by`tn n P ams v i 1 ;207..1,by
who is personally known✓r has produced a who is personally known u- or has produced a
as identification. •� � as Identification. �A
aro r► . ANGIEPERDOMO
• oe`: ANGIt PERDOMO �. °�':
��`' Notary Public-State s• • of Notary Public•State of Florl a
8 , CommissloR�',ilNWg88
Sign tore of Notary Public :;yl� �Oifilffllsion if HH 47988 Signature of Notary Public o! ••° OrM.Expires.Sep 29,2024
a ?�r�,..' My Comm.Expires Sep 29,2024 Bonded through National Notary Assn.
gorced through National Notary Assn,
Print Name o#Notary Public Print Nanti of Notary Public
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Revised 11/16/2016
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