HomeMy WebLinkAboutChange of ContractorPLANNING & 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 PERNIT
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.
X 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: 5/20/2021 Permit Number: 2103-0801
Site Address' 8650 S Ocean Dr 1101-1102 Jensen Beach, FL 34957
Cool and Reliable, Patrick Fletchall State License CAC058567 SLC License 19071
Original GC, subcontractor or owner/builder
/ W VNF A eGtyDM6/ylPJ6, R(,�.Jfk, b6VrZState License (X 2-ON? SLC License 2
New GC, subcontractor
Reason for Cancellation Scheduling Conflicts
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 re , which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cann e capCelljo if workyas been performed.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 1201 _ by
who is personally known to me
or who has produced as ID.
5/20/2021
Signature of Notary Date
Revised 04/15/16
IGN(A_WRE GE gCONTR� YA O�R�(or new GC, as applicable)
/ ` PRINT NAME Q/ ""�fAg-
State of Florida, County of St. Lucie County
The Ilowm ms nt was acknowledg before me t is
day of / 20Z I, by
who is personally known to
��'- Lr`'
me or u
as ID. ��
/2021 ? 3
rN s cv
Signature of No Date
Y''u••.,
g
WALTER 0 PAYNE 11
Notary Public - State of Florida
Commission k HH 32033
My Comm. Expires Aug 25, 2024
" Bonded through National Notary Assn.
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Mayne Air Conditioning and Heating, Inc (Cert. #32115)
have agreed to be
(Company Name/Individual Name)
the HVAC Sub -contractor for Cooke Construction, Inc
(Type of Trade)
For the project located at 8650 S Ocean Dr 1101-1102
(Primary Contractor)
(Project Street Address or 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)
PRINT NAME
COUNTY CERTIFICATION NUMBEJt
State of Florida, County of A
The foregoing instrument was sig�ned/ before me this day of
27-- 1 by
who is ersonally keeewn ✓ or has
/produced
daa
as identificatim
WALTER D PAYNE II
Notary Public -State of Florida
Comn%JAW HIH 32033
gnature of No PublicComm.Expires
Aug My Comm25, 2024
3onded through National Notary Assn.
Print Name of Notary Public
Revised 11/16/2016
COUNTY CERTIFICATION NUMBER
State of Florida, County of lyf-�149 kI
The foregoing instrument was signed before me thisZ y of
who is personally known _or has produced a
STAMP
g'natuure of Notary Public
Print Name of Notary Public
WALTER D PAYNE II
Notary Public -State of Florida
` Commission # HH 32033
My Comm. Expires Aug 25, 2024
Bonded through National Notary Assn.