HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
X 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.
2002E 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. Neal
Date: 5/20/2020 Permit Number: s' au
Site Address: 20025 Southern Star Drive, Fort Pierce FL 34945 mcw- [-),> i e CZ IfWlp
Group One Construction Co.
Original GC, subcontractor or owner/builder -
State License CBC1250688 SLC License 26931
BSL Construction Co.
New GC, subcontractor
Reason for Cancellation Original Contractor Suspended
License CGCO23890 SLC License 21563
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/ ubco tractor or c cellation of permit. A permit cannot be cancelled if work has been performed.
SIG14ATURE OF OWNER (or owner/builder) SIGNATLMP6PNERAL CONTRACTOR GC, as applicable)
PRINT NAME Peter Roussonicolos
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
U day of t• w J 20'7 D by T e-r
.1R-f)(A5SDV1ieZ 105 who is per n y kn wn to me
or who has prodticed as ID.
5/20/2020
c
Signature of Notary Date
PRINT NAME Byron Lenoff
State of Florida, County of St. Lucie County
e following instrument was acknowledg before me this
qC �day
of� /MOA , 20756 by
IX 1 ( I who is perso lly own to
me or who has produced as ID.
� � QI W12012020
Signature of Notary Date
Revised 04/ 5/16)Bonded
MICHELLEDOWELL c�YP�e MICHELL•EDOWELL
e°r`MY COMMISSION #GG265453 r, MY COMMISSION #GG265453
EXPIRES: OCT 07 2022 EXPIRES: OCT 07 2022
C°F through 1st State Insurance" Bonded through 1st State -insurance
Mk 4 /•4,
Planning & Development Services
Building &. Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Permit
Change of Contractor is to be completed 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,
signature, and transfer fee. 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. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date:
Site Address:
Permit Number: I% 0 5— D 6 z
`5 2> a24 i� ad_, State License Lam% ',� License
Original General Contractor (or Subcontractor)
� 6_p�6628�
State License SLC License
New General Contractor (or Subcontractor)
Reason for Change
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.
(._" qkd a
SIGNATURE OF OWNER (or owner ui der) NAT O �EjWW GENERAL CONTRACTOR
PRINT NAME 411� -,A )d MW D PRINT E T. ' U VLJI-W-WO
r—
State of Florida, County of St. Lucie County
The following instrument as acknowledged before me this
day of�120 )7S by
y AM // who is personally lnow to
or who has vro ced as ID.
6e1
Signature of Notary Date
State of Florida, County of St. Lucie County
Theff' ld 1owin instrument as acknowle d before me this
y�day
who is personall ow to me
or who has produced as ID.
Signature of Notary Date
*Only signature required for change of subcontractor
Revised 07/2
vi"' • CRYSTAL DAWN MOORE
MY COMMISSION # GG066605
%, ��•r EXPIRES January 28, 2021
Iw11PA'••,, SYLVIALOMBARDOZZI
MY COMMISSION ;k FF M294
y' EXPIRES: February 22, 2020
... BondedThiuWtaypublic 0ndenxdters
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