HomeMy WebLinkAboutWS 22 - CHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 LOT 22
(772) 4624553 FAX 4624578
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.
Date:
12/R/2021
Site Address: 5136 ARMINA PLACE
FAMILY AIR, INC
Original GC, subcontractor or owner/builder
Permit Number: SLC 2103-0690
License SLC License
I,11.j005TOAM Ur'GAl �JIYyb1111[60 State Licens �� SLC License
New GC, subcontract r
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold harmless S
costs, fees or dam es arising from any and all claims of action fora
contractor/suVontrftr or cancellation of permit. A permit canno h
SIGNA OF OWN (orownerPouilder) SIGN,g7
PRINT NAME KeVln BOrkemhagen PRINT
State of Florida, County of St. Lucie County
The fallowing instmment was acknowledged before me This
24 _.no4 of JUDO on 21 by
ofNomry
Revised 04/IS/16
knotm to me
iS10Dlq HH 1822N
November3,2025
agents and employees fron
as a result of this change of
C. Lindstrom
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
applicable)
2, day of 20 �1,by .xmpc.um.w�,
wh ersonall aim to
me orytohaspr need as ID.
-� CQI2,I?1
Signature of Notary Date
�tkis, ,, LISAGIBBS
_'��'• �' MY COMMISSIONttGG108705
EXPIRES: Aptil 22.2022
t�°o`' BondedThruNolary Publlc Undenttllers
State of Florida, County of St. Lucie County
The fallowing instmment was acknowledged before me This
24 _.no4 of JUDO on 21 by
ofNomry
Revised 04/IS/16
knotm to me
iS10Dlq HH 1822N
November3,2025
agents and employees fron
as a result of this change of
C. Lindstrom
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
applicable)
2, day of 20 �1,by .xmpc.um.w�,
wh ersonall aim to
me orytohaspr need as ID.
-� CQI2,I?1
Signature of Notary Date
�tkis, ,, LISAGIBBS
_'��'• �' MY COMMISSIONttGG108705
EXPIRES: Aptil 22.2022
t�°o`' BondedThruNolary Publlc Undenttllers