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 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.
Date: `4 I n I 2MA Permit Number: 21 0 Z- d2,>2-�7
Site Address: Won 5'}ir4nc,+, Eoyt 9y-e C'e
� \J PIUMbli� MYZC . State License,%.UI-11)7 LC License
Original GC,subcontractor or own r/builder
9YJC1M&)Q in DY�LU�S �i'uilUln n(2 State Licens '-4 "_114WSLC License
New GC,subcontractor J
Reason for Cancellation Lk lclJU t7 C_0nn kQI-c � J 1)h.
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/subcontraeto o—r a cellation of permit.A permit cannot be cancelled if work has been performed.
SIGNA'R4R&Q ER(or owner/builder) SIGNATURE GGAZAItECONTRACTOR(or new GC,as applicable)
PRINT NAME/f�Ft-/fn.�l N_G./Yj S PRINT NAME_fYnQ0.Mi n
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 III inshumegt was acknowledge before me this
day of V j% 202_1 ,byWaA. (4 zMay of A&V I I 20L�,by JC+IIri�n
t✓ �A^ PvCMA'Al who is personally known to me J;Wuf 1C7__ who is personally known to
or who has produced as ID. me or who has produced as ID.
*/%_� y lV_T IZ, 9 Izir IZl
Signature of Notary Date Signature of Notary Date
17
Y Aii ANGIE PERDOMO
Revised �•1 ° ANGIE PERDOMO `�; Notary Public-State of Florid
Notary Public-State of Florida •_� ` Commission k HH 47988
Commission#HH 47988 orr1 My Comm.Expires Sep 29,2024
e4 '" r My Comm.Expires Se 29,2024`�`' P Bonded through National Notary Assn,
,:
' Bonded through National Notary Assn.
PERMIT# 'Z� �2 _ D328 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
•
- -- BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
p�W '!,, Y I G rnb�f- ar DI(C( Vl ) have agreed to be
(Com any Name/Individual Name)
the I(�,Yl(1�D�iit' Sub-contractor for ( (,Lky1S O n--Cs
(Type of Trade) (Primary Contractor)
For the project located at -s�4r'-e� Fyvfi
(Project Street Address Property-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-CONT ATURE(Qualifier)
PRINT NAME f PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of S•Utca'Q State of Florida,County of�'FA• L'LLC'�-C—
Thee foregoing`instrument was signed before me this 2b+d y of The foregoing instrument was signed before me this At day of
.202� bywQJl��I(1� �Y��L3(� it 'S �Q1f ` ,207-11by Oe JMm;n 3iwyCrre
✓� Z
who is personally known or has produced a who is personally known has produced a
as identification. v o., as identification.
;�•a-�'= r{�, �� Notary Public ANGIE P State of Florida
�� ANGIE PERDOMO
'W
� Notary Public.State of:Ffoa 1�1�
!Z�� CommissiC151AW47 ti Commissio 988 mm.Exp1reSSep 29,2024
Signature of Notary Public omm.Expires Sep 2 Signature of Notary PublicBonded through National Nota Bonded through National Notary Assn.
e r
aAna
Print Name of otary Public Print Name of-Notaryublic
Revised 11/16/2016