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 PERAIT
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: June 15, 2021 Permit Number: 2007-0559
Site Address: 8750 S Ocean Drive, Unit 833, Jensen Beach, FL 34957
Luxury Renovations and Additions, Inc State License CGC1523559 SLC License
Original GC, subcontractor or owner/builder
Murphy Homes and Rentals, LLC State License CBC1264666 SLC 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 arise as a result of this change of
contra c tractor or cancellation of permit. A permit cannot be cancelled K work has been performed.
SIGN OF O R (or owner/builder) SIGNA CONTRAC R (or new GC, as applicable)
P NT NME Kim Anderson -P AME Jesse P y
S� of Florida, County of- Vo CW' Cowes rr State of Florida, County ie County
The following ent was ackmowledged before me this
day of 'n� 20�U by K i rn
f 1 Y 1m 5eI' / who is personallyknown to me
or who as ced ( a s ID a.
u June 15, 2021
Signature of Notary Date
Revised 04/15/16 �M ��, Christian Barrios
�e g Notary Public
0 o State of Florida
Comm# HH135507 19
Expires 5/27/2025
The following instrun&lfwas acknowledged before m th's
- I n day of ��� 2(�( bye =T
who is persona to
me oMw asp c tas W
J,.&, J, Gvz r-
Signa a of Notary it,
ozabethP bleak
Notary
State o ��� 08/0512022
ICY Commission Expires
225309
commission No•