HomeMy WebLinkAboutWS 23 - CHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 LOT 23
(772) 462-1553 FAX 462-1578
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 $50.00 fee for the Change of Sub -
Contractor,
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
12/8/2021
Date:
Site Address:
FAMILY AIR, INC
5134 ARMINA PLACE
Permit Number: SLC 2104-0691
License SLC License
Original GC, subcopontractor or owner/builder )������ �
LIQ()61gom U(IG�r�ujfl�i,,c� StateLicensk;t(L7l —SLC License
New GC, subcontractor
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold Irartnles:
costs, fees or d es arising from an�and all claims of action for
contractorls contra ancelrrn llation of permit. A permit cam(
PRINT
state
of Florida, County of S[. Lucie County
The following instmment.vas acknowledged before me this
24 day of June 20 zJ by
vm ore 'a obi personally known to me
a o has roduced as ID.
Snature of 8;; E OLL
i
g ;$ ...• ` MY MISSION# HH 182271
;$tPrEXPIRES: November 3, 2025
Car" nvuNotary K goUnderwaa,
Revised
agents and employees fron
as a result of this change of
IGkJ�l77R��14"F�/AL CBNTRACTOR (ornew GC, es applicable)
PRINTS A Jeffrey C. Lindstrom
State of Florida, County of St. Lucie County
The following inslrmnent was acknowlcdged before me this
ss day of 20'! ,by Hnyc.rwswm
wh ersmrall to
me or o has p need as ID.
IL);t �� CQ�2� Z
Signature of Notary Date
,.�rya„u LISAGIBBS
BonMY COMMISSION IF GG 1rJ8165
EXPIRES: April22, 2022
%�+c°�' ola Public Undem'dtere
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