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
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.
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Date: L) -2.�1 ZO 1_1 Permit Number: '21 0 Z
Site Address: S3 Li LA LQc) 5-t-vPe� v�V' PAS
JUO.�_1Jl.Lt.� p t uf ny1rU State License O RL h I q(�-1�SLC License
Original GC, subcontractor or owner/builder
1 1(AR State LicenseOMI LI-PgS(OSLC License
New GC,subcontractor
Reason for Cancellation Limo 6h
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
contractor/subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner wilder) SIGNATURE CONTRACTOR(or new GC,as applicable)
PRINT NAMY�J, 4a; 6, A�`ti^� C PRINT NAME&n *75 \rOC11P`
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 fQllowing instrument was acknowledged before me this
Z.8}rday of �W V 201L,by W0.� ay of AroY t ,20 A,by N,)CL ' in
lbVNoun NC S who is personally known to me '3 b 1MR-PNr L who is personally known to
or who h KZ
as ID. me or who h s produced as ID.
4ILglz, 945-111
Signature of Notary Date Signature of Notary Date
�►*� ta.;
ANGIE PERDOMO i��°�e•. ANGIE PERDO:79
P, G;Revised Notary Public-State of Florida r Notary PubUc-StateFlori aCommission#HH 47988 a` Commission#HH 88
�o My Comm.Expires Sep 29,2024UW. My Comm.Expires Se
9,2024Bonded through National Notary Assn. Bonded through National Nry Assn.
PERMIT# 2) O'Z _ 02.71 ISSUE DATE
_ PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
�.C1JOlM xl LAX-C,W 'S P I VLYY1b r r1Q E)X 0.i.n have agreed to be
the 'VCompany Name/Individual Name)
1UXy_A)0-e� Sub-contractor for Aol nS ltmo
i
(Type of Trade) (Primary Contractor)!
For the project located at 53 L,P 9 L✓&Q p 'J nyt P►emc
(Project Street Address or Property Tax ID#)
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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) �QS,U�B-NCO R`AC_T GNATURE(Qualifier)
PRINT NAME PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER1 /,
State of Florida,County of S. LkCA-C. State of Florida,County of�. L1LCkR_ -�o�
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this GOB day of
211L1,by WQW1e— lb'NW P aWt I Y ,2021,by r3-mia tiifl 1 nrCJ'►CZ
who is personally known-../.r has produced a who is personally known —'Oor has produced a
as identification. as identification.
"v�••.,• ANGIEPERDOMO
<s`r ANGIE PERDOMO Notary Public-State of Flori a
Notary Public-••_S_ty�e of Florida _y o` Commi ���}}iiH 47988
[ommis� 4gH 47988 �' Comm. 4$ep 29,2024
Signature of Notary Public o°F!,: My Comm.Expires Sep 29,2024 ignature of Notary Public """'Bonded through National Notary Assn.
..
Bonded through National Notary Assn.
I� kyo(O WN� iQ rrA;-e VZYUom O
Print Name 6ONotary Public Print Name 6PNotary Public
Revised 11/16/2016
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