HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
RECEIVED
JUN .2 5 2021
St. Lucie County
Permitting
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
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
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 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: 6� 2`5�.� Permit Number:
-f �a 4
Site Address: � S n � S Z n Ai Q.h � v e t' Y� � "� • 5 �•C '� 3- mz
Q w v, e- - P-A o f r " S i k . Ctate License SLC License
Original GC, subcontractor or owner/builder
State LicensECRC 133 \32. LC License 2-1 5 6 2-
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
contrac or/ ubcontr to or cancellation of permit. A permit cannot a cancelled ifwo k has been performed.
SIGNATURE OF OWNER(oowner/builder) SIG ATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME d�C�S C //�� h PRINT NAME `V'1AC VN� C�
State of Florida, County of St. Lucie -County
The following instrument was acknowledged before me this
C day of % L , 20, by 4O
m , who is personally known to me
o �or�hasced as ID.
iSignature a otary Date
?;st?Y?y;• SHIRLEY LYDERS
Revised 04/15/16 Commission# GG 935991
Expires March 31, 2024
•4^ f,% • � _ Bonded Thru Troy Fain Insurance
State of Florida, County of St. Lucie County
e following i trument was acknowledged before a this
` f/� I day of 2 by V
V ftt IC J?Yl who is personally known to
e o o s pro L DL as ID. • CJt/1
Signature of No Date [�
^t;��'P�•.,
"=
MELISSAJEANMARTZ
Notary Public -State of Florida
• t
Commission; GG 14 ..2
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My Comm. Expires Oct4,202i
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Bcrded throucf: M1aticral M1ctary Assr.