HomeMy WebLinkAboutCHANGE OF SUB-CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 LOT 26
(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: 5122 ARMINA PLACE
Permit Number: SLC 2104-0688
FAMILY AIR, INC State License SLC License
Original GC, subcontractor or owner/builder /� �HU,,�� q �7
bQ() pm Ur JC4—YL111Y amo State Licenser ��_SLC License
New GC, subcontractSr
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold harmless S
costs, fees or d s arising from any and all claims of action fora
contractor/supcco trac r or cat Ilationoef*ermit A permit canno lb
SIGNATU OF
OWN
IY(orownerPouilder)
SIGH
PRINT NAME
K@VIn
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PRINT
Slate of Florida, County of Sir Lucie County
The follo@wyi�ng instrument was acknowledged before me this
24 dG V i J 18 rkenn eff
icpersonallyknewrrteme
a oho produced as lD,
a a-�
Signature of Notary
ter KATHLEEN F INGERSOLL
MY COMMISSION 0 HH 182271
Revised 04/15/16 c�''• +'. EXPIRES:Nevember3,2025
�.r'6u}�e.,",� Bondod Thm Notary FublkUndenvdlen
agents and employees fron
as a result of this change of
'ONTRACTOR (or new GC, es applicable)
C. Lindstrom
Slate of Florida, County of SI. Lucie County
The following instmment was acknowledged before me this
z� day of +��+ 20 z_,by war yc.um,va�
wh ersarall to
me or ro has uced�_as ID�I� I—
S(gnMarc of Notary Date
t��;�•., LISAGIBBS
MY COMMISSION ttG 202�185
E%FIRES: Apri122�
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