HomeMy WebLinkAboutChange of Contractor 1
Oct 19 2021 10:37pm
PLANNING& DEVELOPMENT SERVICES
BUILDING &ZONING DIVISION
I • 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 sighed 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.
ACANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cance ation 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: 2105-0707
Site Address: 3066 NW RATCLIFFE WAY
WILCO CONSTRUCTION INC. State License SCC 131151026 SLC License 29115
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation PROPERTY OWNER HAS ELECTED NOT TO PROCEED W/INSTALLATION OF A BOAT LIFT
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
cc a or/subcontractor ore ellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or o erlbui[der) SIGNATURE GENERAL CONTRACTOR(or new GC,as Applicable)
PRINT NAMS� eP � � PRINT NAME ROBERT WILLIAMS
State of Florida,County of.St.Lucie County State of Florida,County of St,Lucie County
The following instrument was acknowledged before me this The following instrument.Nas acknowledged before me this
day of 20," by day of 20_,-,by
who is personally known to me who is personally known to
or who has produced as iD. me or who has produced as ID.
Signature of Notary Date Signature of Notary Date
Revised 04/15/16