HomeMy WebLinkAboutChange of ContractorPLANNING & 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 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 till 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 - X cf 1 Permit Number: t7 10 6 - 0 3 --`-�
Site Address: d� V�']rl �r Vie. +�C �C C �1/✓lA.I�Sd� 3� i�
`''>° -0 ��� �( � ate License SLC License o? [o)-
l
O��GC, subcontractor or o er/builder
ViJlR1tsC C.
�� -� State Licens CC�C(j�j 71 S(�
_... e SLC License S
New GC,lsubLontractor ,
Reason for Cancellation C/ Uj rjc-j(- Oe C- ( .S l 6!`.1
The undersigned does hereby agree Lo indemnify and hold harmless St Lucie Count), its officers, " ents and mplovees from al1
costs, fees or damages arising from any and all clai s of action for any reason w ' may se a, result f this change of
c tr ctor/s bcont r or n ermit. A permit cannot ncell if w as een r d.
i. r cat' ( ER r owner/builder) SIGNA E GENERA
JL CONTRACTOR for w Gc. as applicable)
PRINT NAME potwrrw�ense ,C?1P
state AQ. County affii �y Co'
The following instrumcni was arknowlodged before me this
tav of �Ua .9 _ . 202 , by
Ito is personally known to me
or whoepdwhoaced as
Slgnaturc -1 s-Wr% bate
iL1 �rikr .ji/r
State of Florida, County of St. Lucie County
The following inlet anent was acknowledged before me this
,9,L 3 clay of �. 20a, by
/tC -;( who is perunau3cYpowa to
A-tur,
pcSohtry U A (r % 1 Z/
BARBAitA S RIZZOTTO
z°f 1r Notary Public - State of Florida
Commission x GG 930186
M-� Comm. Expires Nov 7, 2023
B ndec through National Notary Assn.
a � PLANNING & DEVELOPMENT SERVICES
31 BUILDING & ZONING DIVISION
® 2300 VIRGINIA AVE
a
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERM
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 jtib values ,greater than S2,500 (S7,500 if AFC 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 till out a Subcontractor Agreement Forn3. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERIY£1T - 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 - X � I
Site Address: 6 a- W 1*M CSC'_, C e e-
cc_ Cie �&-�z (C60�cac,
Permit Number: j! D G- D 3
License SLC Licensed
'Original GC. subcontractor or over/builder
,Ct
State Lrcensc, 65%S(0 SLC: License
New 0C',/ ttbcontrictor
Reason for Cancellation 0 1\JCC j0e_ C S `6AJ
The undersigned does hereby agree to indemniry and hold harmless St Lucie County, its officers, � gents and mployees fmn
costs, fees or damages arising from any and all clui s of action for any reason i may rise "result f this change of
c tr ctorls bcontr or or n ennit.'A permit cannot ndell if w a een r r d.
U OF ER rctwnedbuilder) SICiNA'fl. F GENERAL CONTRACTnR (or w GC,, as applicable)
PRINT NAME t " � Ls��+►��rtari�l
Stcttc pf AQ, Clawlty of y '
1711e foilowutg iostr%; nc��al Was acknowledged before me this
lay of Ni1e%%k @A. by _
_ hu is personally known to me
Sig"otura of Nowrr - Date
State of Florida. County of St. Lucie l.'ounty
The following it It urnwa was acknowledged before tire 111is
is persowfly i+'tt9+Nt to
'Ile orj has�pnuccd 1; �.
Si nature of Notary
BARBARA S R122gTT4
Notary Public • State of Florida
q� s Commission N GG 930166
o. n Mp Comm. Expires Nov 7, 2023
Bendec through National Notary Assn.