HomeMy WebLinkAboutChange of Contractor DI]LANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
'+<tA 2300 VIRGINNIA AVy;+ RECEIVED
� e Li �la�'�s Ll V "R_a
FORT PIERCE, FL 34982 MAY 11 2021
(772) 462-1553 FAX 462-1578 . 'irmltting Department
i. Lude Count'
CHANGE OF CONTRACTOII. SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT:ONE OF TNETOLLOWING:
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 game
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 $50.0.0 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.
_X_CANCEL,LATION 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..
Bate: 5/1,0/2021 Permit Number: M-2104-0771
Site Address: 1 °� �ta-. 1� � •
State License SLC License
Original GC, subcontractor or owner/builder
State License _ SLC License
New GC,subcontractor
Reason for Cancellation Contractor wasn't including all roof areas,..going with another Roofing Contractor
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its off treys,agents and employees f.Qm 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 pertnit.A permit cannot be cancelled if work has been performed.
�Oa t� --
OF OWNER(sir oumedbullder) SIGNATURF GENFFRAL CONIRAt'TOR(or new GC.as applihablc)
PRINT NAME J D� to o 64O ltJ PRINT
State of Florida,.County of St.Lucie County Stdte of Florida:County of SL.Lucie County
The'follbwing instrument was acknowledged before me this Tile following instrument was acknowledgco before me this
l c clay of N-, 2Q by ___.day of
who is, ersonall UWln to
vdio is personally known tonne P Yo
or who has prodiNcd \f - - as It), me or who has product d as III.
_ Smote dWodd®
Signature of Notary ' otev puPt6 diet G i92 Signature of Notary Date
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Revised 04/15/16 h+oyOf