HomeMy WebLinkAboutWS 19 - CHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 LOT 19
(772) 462-1553 FAX 462-1010
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:
12/3/2021
Site Address: 5150 ARMINA PLACE
FAMILY AIR, INC
Original GC, subcontractor or owner/builder
Permit Number: SLC 2103-0684
License SLC License
1110425r2nM Dr IG4-YIi1CYli�ktrD State Licens�SLC License
New GC, subcontract r
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold hannles,
costs, fees or da gas at g from any and all claims of action for
contractor/su=tt nseAa ' n of permit. A permit can�m
SIGNATURE F OWNER wner/builder) S101
PRINT NAME evin Borkenhagen PR
State of Florida, County ofSt. Lucie County
'Itie
or ha roduc •I a' KATHLEENF.O
'1'' MYCOMMISSI0
agents and employees fron
as a result of this change of
ONTRACTOR (or new CC, as applicable)
C. Lindstrom
State of
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zr LISAGIBBS
o' MYCOMMISSION122 2022
,JOA,� EXPIRES: APril22, 2022
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