HomeMy WebLinkAboutCHANGE OF SUB(BP#21040-0606)1
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PLANNING &DEVELOPMENT Si
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 4624553 FAX 4624578
F THE FOLLOWING'
CONTRACTOR —Change of Contractor is to be signed and notarized by the propel
anD me new convaaor of record for the current permit. A new permit application must also be completed with n
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's na
for job values greater than $2,500 ($71500 if A/C Change -out). A recorded copy must be submitted prior
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 contract
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Si
Contractor.
L�' CANCELLATION OF PERMIT— The cancellation of a permit is acceptable only if no work has been do
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee
cancellation of the permit.
Date: 05/27/2021
Site Addre55: 5116 Silver Oak Drive., Fort Plerce Florida 34982
CARDINAL ROOFING
Original GC, subcontractor or owner/builder
Permit Number:
2104-0606
9072
License SLC License
Collins Roofing Inc. Stale License CCC-058011 SLC L
New GC, subcontractor
Re n for Cancella
e undersi do agree to inde nify and hold har ss St Lucie Co , i officers, agents
costs, fees d g risi g f any an all claims of ac ' n for any reaso i an a as sl
cor no o ctor c�Jla�ion permit. A per a cannot be w Or h en per
OP O WFErrtrrr ownerPouilder)
PRINT NAME Christopher Collins pmg�y
State of Florida, County of St. Lurie County
7be following iyynsyyw77,,m,��en''t was adm��orrwlcdged he(ore me this
day of 20v�, by
who ! personally known to me
o has produced as m.
OS Z awl
Sign o pate
CASEY FRENCH
Revised 04/15/161 /ILL t NotaryPuMc- 1 leolnonda
Comm , op 0 GG 167258
7. i YC Exiles Dec 11 2071
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employees fror
this change of
CIOR (or new GC, as applicab
rher Collins
State of Ilodda, Cpunry of St. Lucie County
7be following inswment as acknowledge�,before qre this
day of _ ✓Yln.r-202�by
��"I' who personally known to
�or*hmdu as
o5a7W2r
gnaDate
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