HomeMy WebLinkAboutChange of Contractor PLANNING& DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OIL 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 PERIWIT—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: Permit Number:
Site Address: Y`fi p`�Y(��
VIACRI& Ll Y State License ZDS09-1 SLC License
li Original GC, subcontractor or o er/builder
QKY'',', 1 DfE k A t� e1 WY) nQ State License C al!LV LC License
New GC,subcontractor
Reason for Cancellation US- 1WOU tO CQft-,Q 1-C+f_ )o 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 tracbcontractor or cancellation of permit.A permit cannot be cancelled work ha en performed.
SI•MATURE OF OWNER(or owner/builder) SIGNATURE G¢N-E CONTRACTOR(or new GC,as applicable)
PRINT NAME6v/,. + fy j` �M- PRlNTNAME fp=QQ r!( -,n �I fflPli?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 Tl e_&1owing instrument was acknowledged before me this
2%*day of Af Y i 1 ,201 11 ,by� �t"^day of ,20- ,by �i(1
�fN4= b QMS who is personally y known to me . who is personally knowgi to
or who hhas produced as ID. me or who hn produced as ID.
Signature of Notary Date
� r'Y Signature of Notary Date
S rY
Y0•„ ANGIE PERDOMO 4d+YPv ANGIE PERDOMO
Revised 04 Notary Public-State of Florid :po I Notary Public-State of Florid
i`a ei Q3
c;= Commission#HH 47988 e, Commission H HH 47988
�. = ®r
My Comm.Expires Sep 29,2024 orr�;,. My Comm.Expires Sep 29,2024
Bonded through National Notary Assn. Bonded through National Notary Assn.
i
PERMIT# '2J V-2— b, l ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
COUNTY
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
lew. )rl A Ir-) DE LU"5 P I tAM b d 4' J)1(CL,I n have agreed to be
(Company Name/Individual Name)
the �(LLlIYIbJr Sub-contractor for Naffs ftu ess
(Type of Trade) (Primary Contractor)
I
For the project located at �j��-Q Ste''
(Project Street Addre s or perry Tax ID#
i
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)
PRINT N PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of-5},W�G C. State of Florida,County of 51 •L U-
The foregoing instrument was signed before me this Z&day of The foregoing Instrument was signed before me this 2 �d�ay of
2021,by WNINC WS IOA-% ndams v 1 ,2021,by
who Is personally known or has produced a who is personally known vol"or has produced a
I
as identification. as identification.
(fAY Pt%•''•; ANGIE PERDOMO ►*Yp�'••• ANGIE PERDOa24.
_°•� ��= Notary Public-State of Florida s�: Notary Public•State�• Commiss&1iAIri1fP41988 Qi Cammtsslog# �1
Signature of Notary Public '•..,or My Comm.Explres Sep 29,2024 Signature of Notary Public '•.pF n;,, omm.Expires.Sep
Bonded through National Notary Assn. Bonded through National N
Print Name of lqdtary Public Print Nanil of Notary Public
I
I
Revised 11/16/2016