HomeMy WebLinkAboutChange of plumbing subPLANNING & 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
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 mast 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: _T1 I of I
Site Address:
Yvl
Permit Number: Do Is - d a a L
uyi l I r" I t "' State License SLC License (� 1
Original GC, subcontractor or owner/builder
&aWU
fl i r State License D J SLC License
New GC, subc ntractor
Reason for Cancellation
The undersigned does h(
-- —•• ••�•� ••-1... ao or i uwu t.oumy, its orricers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, ich may arise as a result of this change of
contractor/subcontractor or cancellation o,•,11f permit. A permit eP t he ca rl w� rk hac heon nprfnrmed.
SIGNATURE OF OWNER (or owner/builder) I " � I � o` ` I •`— 1
NATURE G R (CONQTRAI CTO ( new GC, as applicable)
PRINT NAME • V Q YJ 1 1� u I l t' f PRINTN AME � J � •(j (l � 01 n (1 In 1 S
State of Florida, County of St. Lucie County
The following inst`niment was acknowledged before me this
day oaf^, J�� , 20� by
N +h+hb is personally known to me
c} YI'R 11 s ID.
Signature of Notary
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State of Florida, County of St. Lucie County
flowing in ru ent ack wledged before me this
day 0{ ` 2[, by
( • 1AIlIqLwho is personally known to
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Signature of Notary
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