HomeMy WebLinkAboutChange of Contractor 4e4
, µ r� PLANNING & DEVELOPMENT SERVI S _-
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
%9;
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
. I
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
I
P E 7 SELECT ONE OF!THE FOLLOWING:
CHANGE OF CONTRACTOR-Change of Contractor is to be signed and notarized by the property owner,
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-
Contra
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: 2 a Permit Number:
Site Address: //9'
State License SLC License
Original GC,subcontractor or owner/builder
State License SLC Licensee /�-
New GC,subcontractor P,�e_5 2D
Reason for Cancellatio
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
contract o co ct ca ellation of permit.A perminnot be cancelleo if work has been performed.
S GNATURE OF OWNER(or owner/builder) J„ SIN R(or new GC,as applicable)
PRINT NAME � C 29� PRINT NAME. e ,_ 29 -t�-
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following r ent was acknowledged. fore me this The following instrument was acknowledged before me
this
day of Q� 2 by� —+ day of A71��20�byt< 'ti+aerG. 'f~"
o is personally known to me who is personally known to n
or ced as�. me or who has roduced as Q � G Zk
Q
J�gk,�
� �SPflYp�� ll
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Signature o a° oa;; Da Signature of Notary Date
,,a _scat CCF
PPP; e°;n Of/�°a�AUGL'I l �.
Fi° `� ll%! aissio a'Notary :ivP4P;,, ELLEN VAUGHN I
Revised 04/T Y Corn n i GG y Pubp ?° �`� State of Florida-Notary Public i
�. Depobe.02, Fk"0079° =N Commission # GG 270079
PP'2pp �res %�m0FF�oP°.' My Commission Expires
°`""`�� October 22, 2022