HomeMy WebLinkAboutWS 37 - CHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 LOT 37
(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:
12/8l2021
Site Address: 5133 ARMINA PLACE
FAMILY AIR, INC
Original GC, subcontractor or owner/builder
Permit Number: SLC 2103-0702
License SLC License
U>anSrRt)M h 1G4�1tvu&trJ[n State Licenst���_SLC License
New GC, subcontract r
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold hartnles:
costs, fees or S46fit actor o g frotp i `ny andoar claims of action for
contractor/subSo'tractor or dance a ton of ermit. A permit canoe
PRINT
Stele of Florida, County of St. Lucie County
The following instmment was acknowledged before me this
June �n 21 L..
known to me
agents and employees fron
as a result of this change of
GC, as applicable)
C. Lindstrom
State of Florida, County of SL Lucie County
The following instmment was acknowledged before me this
sr day of +w 20 z� ,by
wh egnouall v to
aig_orAo has produced as to.I I
MISSION # HH 182271
Signature ofNotflty a. E* Si flturc of Notary Date
P; EXPIRES:November3,2025
'%:'te'sih;•"•`' BondedThmNotaryPuNbUnddarilers
Revised 04/15/16 :�•„• LISA GIBBS
`Fv� MY COMMISSION # GG 108185
.;r EXPIRES: Aptil 22, 2022
od ;;a' Bon
lets
dedThmNolory PubllcUndensd