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HomeMy WebLinkAboutSubcontractor Roof- Updated PLANNING & 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, 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 comme cing 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: a g- © ms�� Site Address: aC 3 Grove State License SLC License Original GC,subcontractor or owneribuilder State License SLC License New GC,subcontractor Reason for Cancellation 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 c d if w rk has been performed. A4 SIGNATURE OF OWNER(or o /builder) ll SIGNATURE GENERAL CONTRAC or new GC,as a licable) PRINT NAME t 1' (�/V PRINT NAME `' State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County The following instrument was acknowledged before me s The following instrument was acknowledg be ore me s QC�day of 200� Q a L�;�1�� �ay of� 20�by b y�� R 2c0t� who is personally known to me -C'Q e-11 ©I\ who is personally known to or who has produced L as ID. me or who has p ced�,t>J— as ID. 4 A.1 � q 3o�at �3o�a l Signature of Notary Date Signature of Notary Date =o,PaY Pce<< NADINE MANRESA o�Pciv ru9�4 NADINE MANRESA Commission#GG 355203 = Commission#GG 355203 Revised 04/15/16,fVF,OF,:, Expires November 15,2023 Expires November 15,2023 ^'d rhru Budget Notary Sorh:es Sl",F v�69' Bonded Thru Budget Notary Services PERMIT# ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division COUNTY �__..�. BUILDING PERMIT SUB-CONTRACTOR AGREEMENT Ciwi have agreed to be (Comp ame davidual Name) the O Sub-contractor for (Type of Trade) (Primary Contractor) For the project located at a g 0 3 rO y e_ C (Project Street Address or Property Tax ID#) It is understood that, if there is any change of status regarding our participation with the above mentioned project,the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub-contractor notice. V ColYrITACTUR SIGNATURE Qu7vawi SUB-C RACTOR SIGNATURE(Qualifier) N PRINT NAME P N a3 0 ` 1�' COUNTY CERTIFICATIONMNUUMBBR COUNTY CERTIFICATION NUMBER ,� State of Florida,County of —�— V C« State of Florida,County of1d�Cl The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this y of 2�1 by 20��,by 1 I who is personally known or has produced a who is personally known or has produced a as identification. as identification. STAMP STAMP gignatiure o otary Pu blic Signs re ofI otary Public 0W_ 5 a— Print Name of Notary Print Name of Notary Public r°tP�v r�e�c NADINE MANRESA �Pnv o NADINE MANRESA Commission#GG 355203 a° �'o Commission#GG 355203 Nr � o� Expires November 15,2023 9jF o�' BondedThruBudgetNolaryServices ,P t"J o� Expires November 15,2023 of e� �fFor r�o2 Bonded Thru Budget Notary Services Revised 11/16/2016