HomeMy WebLinkAboutWS 24 - CHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 LOT 24
(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.
xxx 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.
12/R/2021
Date:
Site Address:
5130 ARMINA PLACE
Permit Number: SLC 21 a4-0699
FAMILY AIR IN State License SLC License
Original GC, subcontractor oroowner/builder
Uuf)STRt)M tat IG4 -YL 111Y1f 5)K1 0 State LiccnsJCfiDZLfl71 SLC License
New GC, subcontract r
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnity and hold harmless S
costs, fees or da rising from any and all claims of action fora '
contractor/sub ontraqWanceHatiwx.of permit. A permit canno h
SIGNATU OFOWN orownerPouilder) SIGH
PRINT NAME Kevin BOfkenhagen PRINT
Stele of Florida, County of St. Lucie County
j
,�L r r r r
i•
Revised 04/15/16
agents and employees iron
as a result of this change of
'ONTRACTOR (or new GC, as applicable)
C. Lindstrom
Slate of Florida, County of S[. Lucie County
The following instminent was acknowledged before me this
day of � 20r=,by lNf'nc. unaroa�
wh ersonall to
me or ohhaas.pr need as ID.
YifA H (2 L
Signature of Notary Date
LISAGIBBS
MY COMMISSIONif GG 1081fl5
EXPIRES: April 22,2022
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