HomeMy WebLinkAboutChange of SubcontractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE Lcounty,
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-157832019ST. LuciPermitting
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:
Permit Number:/ 1% 2 -- 0 J 2eery
Site Address: / / e- , P i i)er -
%1// /; h .,_( State License SLC License
Original GC, subcontractor or owneribuilder
S `' 1, o e, IP.„ I (,� � State License SLC License t!7 CJ%
New GC, subcontractor
Reason for Cancellation /)I �/I� �'� /ty/ � QG 4kiy'I , r�'t �� "/`l Ile' �� r�r
� en::l�6
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
contractor/subcontractor or cancellation of permit. A permit cannot be cancelJed if w k+h_aass been perfo med.
SIG u OF OWNER (or owner/builder) SIGN G E RAL CONTRACTOR (or new GC, as appli lee
PRINT NAME PRINTNAME
�'
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_ by
who is personally known to me
or who has produced as ID.
State of Florida, County of St. Lucie County
ollowing in ent was acln wledged before me this
day of I2(X, by
JWL
0 ''rrIN 1w�ho� its personally known to
me or who bas produced i►'(4 Dt"s ID.
Signature of Notary Date Signature of Notary;.��'r'Pafe KA R E N S. N I E L S E N
SOS'
eState of Florida -Notary Publi
=► •c Commission # GG 207484
Revised 04/15/16 My Commission Expires
�''!..iiii��; ` June 12, 2022