HomeMy WebLinkAboutWS 33 - CHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 LOT 33
(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/S/2021
Site Address:
5117 ARMINA PLACE
Permit Number: SLC 2104-0692
FAMILY AIR, INC State License SLC License
''O••riginal GC, subcontractor or owner/builder
I,11. t)MoM NJC,4 � Llwu 1PI& State LiceriscCAO SLC License
New GC, subcontractSr
Reason for Cancellation Non -Performance
The undersigned does hereby agree to indemnify and hold harmless
costs, fees or dam es arising from any and all claims of action for
contractor/sub(ntract.o nceUat oKII fpermit. A permit canno
SIGNATUR09ZOWNER owncdbuilder) SIG
PRINT NAME Kevin Borkenhagen Pin
Slate of Florida, County of St. Lucie County
The following instniment was acknowledged before me this
24 ay of June 21 b
i0V1�11 ersonalit ly known to me
4
of Notary
Revised 0
4/I5/16
KATHLEENF.IN
GERSOLL
fYe6MMISSION q HN 18227
EXPIRES:November3
,202b
agents and employees fron
as a result of this change of
m
C. Lindstrom
Stale of Florida,
County of St. Lucic County
The fallowing inslrwnen[ was acknowledged before me this
day of + 20 xJ by xnac. uro,w�,
wfi ' ersonall m to
of Notary Date
LISAGIBBS
MY COMMISSION # G 2022165
_r;.o EXPIRES:Aplil22,
'.?;nri�"c•' BondadThry Notary Public Undeiwrilors