HomeMy WebLinkAboutChange of ContractorPLANNING'& DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
RECEIVED
23.00 VIRGINIA AVE
FORT PIERCE, FL 34982 OCT 0 12021
(772) 462-1553 FAX 462-1578 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. i
Date: I �� l Permit Number: boo 06 (
Site Address: � LaR Q U�-I V, , )' Q P t V L VE-R
l f6Q Vzk�
ALL 914 R,q'V W�cl`kL C, Cr�tJTP PtycR State Licensel (bSLC License -'
Original GC, subcontractor or owner/builder
N�
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 bey fancelled if work has been performed.
SIGNATURE OF OWNER or o /buildelrr)) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT. NAMEu �/V /- A30 PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of C 20� by Kn% Yl
who is personally known to me
oy . hasp ucecj as ID.
6ignature of NdtaF
Datk _
JESSICA LYNN JONES
n, Notary Public - State of Florida
Revised 04/15Commission # HH 029659
My Comm. Expires Oct 15, 2024
nded through National Notary Assn.
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_, by
who is personally known to
me or who has produced as ID.
Signature of Notary Date
PERMIT # S LC - ao8 G 4J ISSUE DATE / 2 )� J �02 C)
PLANNING & DEVELOPMENT SERVICES
RECEIVED
Building & Code Compliance Division
OCT 01 20?1
BUILDING PERMIT St. Lucie Count
SUB -CONTRACTOR AGREEMENT Permittir•,
St Lucie Electric/ Jason Raulerson
(Company Name/Individual Name)
the Electrical
(Type of Trade)
have agreed to be
Sub -contractor for A)ERA - Owio k eSul LW
(Primary Contractor)
For the project located at a pos c y�dyrz_ nR/l/'r-
(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.
�CTOR r
�i
COUNTY CERTIFICATION NUMBER
State of Florida, County of �y %t.LC_i —
The foregoing instrument was signed before me this J- day of
UCb.e , zoo t, by 016LnC{ �J Prg,e /OYl
who is personally (mown Ae5r has produced a
as identification.
J e-.,:.,>sI c�
Print Name of Notary
Revised 11/16/2016
:$fir► JESSICA LYNN JONES
Notary Public -9WA PFlorlda
Commission # HH 029659
\of rti My Comm. Expires Oct 15, 2024
1 Bonded through National Notary Assn.
(Qualifier)
Jason Raulerson
PRINT NAME
31537
COUNTY CERTIFICATION NUMBER
State of Florida, County of S4 ' L u c
The foregoing instrument was signed before me this day of
,2ff ,by�TgSol ulerson
who is personally (mown �or has produced a
as
Signature of Notary Public
i SF)Q M0Y-_-hn
Print Name of Notary Public
; s:t MEUSSAMARTIN '
;,,• MY COMMISSION 9 GG OWN
olZ EXPIRES: Febm" 27, 2024
o n,, ftn MI T Ma N0Wy Publb Ulld/rNtNM�
STAMP