HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECENED
2300 VIRGINIA AVE JUL 2 9 2021
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 PerrmittiLucie ouriv
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 ne subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Con actor.
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 p7z-,
it.
Date: Lot Permit Number:a \Q�5�
Site Address: �e' a'✓ 16",
State License SLC License
�gina�,ilbc,(htractor or owner/builder
State License SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Luci6 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
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owne builddeeerj) GNATURE GENERAL CONTRACT�0 (or new as applicable)
PRINT NAME Z-*`G/A,[ K dV ram' PRINTNAME-•
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_ day of I-, V 20 M by l-o� � ` 6i
Q h 2.L R \ c 61, who is personally known to me
,Z e who has produced T'k- � as ID.
Signature of Notary Date
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Signature of Nota'�
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DEANNAGIVcNS
Notary Public - State of Florida
Commission # HH 086359
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My Comm. Expires Jan 28, 2025
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through National Notary Assn.