HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
BfJILDING & 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: Q Z&O /
Permit Number: ;� a03 - otly 7 V
Site Address:�''
:O N%EL � O m C R O State License SLC License �+ -/� /U
Original GC, subcontractor or owner/builder
,-7 L%
1 State Licenser,/. License
New GC, subcontractor
Reason for Cancellation
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 arisM a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be ca celled ' rk ha ee ormed.
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SIGNATURE OF OWNER (or o ner/builder) SIGNA GENE% LCO CTOR (or new GC, as applicable)
PRI 'T NAM PRINT NAME I I t 1AIrn -_I�eft C,-�
/ /
State oVof20_
Lucie County
the focknowledged before me this
20�, bywho is personally known to me
or whoas ID.
Signature
Revised 04/15/16
State of Florida, County of St. Lucie County
%53s acknowledged f e e this ��y�
_wt{p is personally known to J � �
3Public
UMPHREY
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