HomeMy WebLinkAboutChange of Contractor (2) Oct 19 2021 10:37pm 1
..................... - _. _.... . EUIL�DINNG& ZONING DIMS T SERVICES
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2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1518
CNI\ 1� -�-� BCONTRACTOR OR CANCELLATION OF PERMT
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Y Inge of Contractor is to be signed and notarized by the property owner,
permit.Anew permit application must also be completed with new
Y, Ace of Commencement must be fled in the new contractor's name
F A/C Change-out). A recorded copy must be submitted prior to
ar the Change of Contractor,:
Subcontractor changes are to be completed by the general contractor.
ictor Agreement Form.There,is a$50.00 fee for the Change of Sub-
.
e cancellation of a permit is acceptable only if no work has been done,
irized by both the owner and'qualifier of record. There is no fee for
Date: d— 2 O ` Permit Number: 2105-0707
Site Address: 3066 NW RATCLIFFE WAY
WILCO CONSTRUCTION INC. St U C vv1 C�I 4
Original GC,subcontractor or owner/builder \ �J
St
New GC,subcontractor •``� -
Reason for Cancellation PROPERTY OWNER HAS ELECTEI =T
The undersigned does hereby agree to indemnify and hold harml d I I ' n all
costs,fees or damages arising from any and all claims of action'
co a or/subcontractor or c ellation of permit.A permit cal
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II
SIGNATURE OF OOWOWNER(or o, er/builder) 5 1
PRINT NAN!=ldA
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State of I'horida,County of St.Lucie Cotmpr
The following instrument ttias acknowledged before me this
day of 20_by day of 20 by v
who is personally known to me who is personallyl known to
or who has produced as ID. me or who has produced as tD. 3
Signature of Notary Dale Signature of Notary Date II
Revised 04/15/16
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