HomeMy WebLinkAboutWS 45 - CHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 LOT 45
(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:
12/6/2021
Site Address: 5165 ARMINA PLACE
Permit Number: SLC 2104-0635
FAMILY AIR, INC State License SLC License
Original GC, subcontractor or owner/builder
bvjoe oMb,)C,4Llwgggo State Licens b SLC License
New GC, subcontract r
Reason for
The undersigned does
costs, fees or damages
PRINT
Non -Performance
to
claims of action for
Stale olFlorida, County of St. Lucie County
The following instmment was acknowledged before me this
Revised 04/IS/16
Iati1�YY
agents and employees fron
as a result of this change of
ONTRACTOA (or newGC, as applicable)
C. Lindstrom
Slate of Florida, County of St. Wcie County
The following inslminent was acknowledged before me This
es day of .ti^r 20:�by xe�a e.um.w„
wh oersona1IV1D M to
me or ro has pr aced as ID.I z' `I
S(gnature of Notary Date Karl
1"lyo,,, LISAGIBBS
MY COMMISSION #! GG iS8165
EXPIRES: Apri122, 2022
i;r' Bondad-fhm Notary PubllcUIVIOn" M