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PLANNIVG & DEVELOPM NT SERVICES
BUILDING fc ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 4624553 FAX 462-1578
1
CHANGE OF CONTRACTOR - Change of Contractor is to be signed
and the new contractand notarised by the propertycontractorof 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 tiled in the new contractor's name
for job values greater than S2,500 ($7,S00 if A/C Changeroutl A recordod copy must be submitted prior to
commencing any work. There is a SWO fee for the Change of Contractor.
x CHANGE OF SUBCONTRACTOR _ Subcontractor changes
The new subcontractor must Ell out a Subcontractor we to be completed by the genera! contractor.
Contractor, Agreement Form. '!'here b a t50.00 fee for the Change of Sub -
CANCELLATION OF PERMIT - The cw=llation 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: Q Z i i Z-1 Permit Number: aU O (a ' 6i,:)')
Site Address: _ 555)3 %} -f rf c ! (' ,
' 'g -' f rflAL 23 D State Li
Original CC, subcontractor or own der J0JSLC License
Aqua Dimensions Plumbing Services state License CFC057526 18628
New GC, subcontractor LC license
Reason for Carimitation �1 �k
The undersigned does hembY A" to iademnit a and hold harmMER(W
cers eosu, fees or damages arising trorn any and ell calms ofaalon sp� and employees ft'om all
-nstor/:oCtor yr cancellation of ass a uh of this chair of
permit A permit abrmed.SIGNAWRE OFOWNER (or ou4.S
PRINT [PJIttE {� ne4vGC, applrcobre}
PRmNAwE Robert Ludlum
SWe or Flonda. County of St Lucia Coauy
7tte fallow tg abltr MMI tins aduta left d before 1ne"
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or a o hits pto '1��q1■-1I ID
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5t�aamrt of hofllry Dole 4(u l Z(
Revised 04/ / � Notary Public Stain of Fonda
Hannah E Mwe
My Commission HH 01709$1
Id; Expires WiD 2024
Sb to of R0ndk County of St tune Coumy
dayor� 2� before me this
u
Notary Public State of Ftonde
Hannah E Moore
M My Commission HH 017099
@ dC Expires o7ro1►242a