HomeMy WebLinkAboutshinglesPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
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 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: NUV- Hi 1 ZON
Site Address: 100 BEDFORD, FORT PIERCE, FL 34946
Permit Number: C2107-0602
RRCA State License CCC1330395 SLC License
Original GC, subcontractor or owneribuilder
JCM ROOFING & RESTORATION State License CCC1332961 SLC License
New GC, subcontractor
Reason for Cancellation AFTER 3 MONTHS, WORK STILL NOT STARTED
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fror
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 be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME ANNIE DAVIS
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
20_, by
who is personally (mown to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
14qi
S TURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINTNAME PAUL JUDSON
State of Florida, County of St. Lucie County
The following instrument was acknu,QQ]edged beforeme this
day by L-'—oscu
me
h-
Notary Public Stale of Florida
Ashley Dunne
My Commission GG 944276
Expires 01/21/2024
to
1t1211 Z1
11 PERMIT # I /' 1 r\ _ I ISSUE DATE I '� I °.�'� I z'O2'l I
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
���� •yw.y �ausraumenuLLal rName)
the 90cl-c
(Type of Trade)
For the project located at o
(Project:
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for t 5{ Q tu4tr , t
(Primary Contractor)
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.
C'jO�N1'ftAQ'OR SIGNATURE (QuaBBer) auu-a.vrvrsw(,TO SIGNATURE (QoWtner)
PRINT NAME PRINT NAME
COUNTY CERTIFICATION NUMBER k
State of Florida, County of � r� 0 t
The foregoing instrument was signed before me this tv .1'day of
L
who is Personally known --f—
Revised 11/1612016
COUNTY CERTIFICATION NUMBER Stateof Florida, County of 11-1dy.
T,,fhe��foregoing instrument was signed before m[eylt�h/ia�jA� /day of
f 1. 'R✓✓i r ,20_i by 4Ce-,.. '(Y' YurR'Giyin�.
who is personally known j—or has produced a
as identification.
STAMP
��Qr.dT Sagnsture otary Public
Print Name of Notary Public ---
YNotary Publk Stateof Flodda
Marlene SeguraMy CanmimiM HH 091227
Eapuaa 02/10/2025