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
PLEA E 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: Permit Number:
Site Address: �020 at,4Ynia o kjo
44. N erce 12. 3Y9Y:7 State License SLC License
Original GC,subcontractor or owner/builder
fState License 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
contracto s bco tractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
q'7;�IGNA4URF6f O. (or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME pwuJQ&k u 0 PRINTNAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following
ng instrument was acknedYe4�bef is The following instrument was acknowledged before me this
Z�e of .l1 , ,20 b 1W day of 20_ by
who is personally known to me who is personally known to
or who has produ as ID..V�L me or who has produced as ID.
Y Signatureo" `a state VA U G F►N Signature of Notary Date
of Florida-Notary Public
9� P\o`` Commission #GG 270079
"I. ���. My Commission Ex
Revised October 22, 2022 res
CARPORTS ANYWHERE
"Where quality meets service"
Permit#1104 , 'DID 3I
Address. ?Zb Hgrfm a n Rd i fir+ Vi erce i rL 3401HI
1,James Player, Qualifier of Carports Anywhere is giving authorization for the
permit listed above to be switch to an owner builder permit. Removing
Carports Anywhere as the contractor on record.Currently Carports Anywhere
is experiencing a material shortage and are unable to fulfill the order.
Thank you,
James Player
State of'FIoirid of County of D r'Ad-Fo r4
The foregoing instrument was acknowledged before me thisZO day of
Tylu .20 Z , by who is personally known to me or has produced as
identification and who did/did not take an oath.
Signature of C ntractor Printed NarrtL license Number
1
lira, date IQ 12 t?
Signature of Notary
Commission Number
Printed Name of Notary
MARIA R.BURGIN
82849
Commission it;G�^� ,
;s• b`= Expires Augur,!25,2023
.ao;�1�•' BondedThniTmyl�,.inliisurancr.800.38530