HomeMy WebLinkAboutChange of Contractor- owner builderPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
COUNTY 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERNIT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
d 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 PERNUT — 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: (p I awA Permit Number: SL - a ► o 4 - oL,G-9
Site Address: �ea VcKj P1 cru-
/&4 ex,- �OV Li State License SLC License
Original GC, subcontractor or owner/builder
d LL4VGlf , b 411 !,� State License SLC License
New GC, subcontractor
Reason for Cancellation L'OA 017,eki w
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 cancelled if work has been performed.
SIGNATURE OF OWN (of-owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME N1e1- Ssa -1 CoHiI 7_k
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of5_-de, 20 2 f , by
who is personally known to me
or who has produced ee ,, __ // as ID.
�5�/3.�
PRINT NAME
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.
Signature of Notary Date a of Notary
HEATHER FlBURFORDbiic
i'pY PUB i
State of Honda-Nota183Zt�
Revised 04/15/16 .= Commission # GG
Expiree
y� P
My Commission
February 06,2022
Date