HomeMy WebLinkAboutchange contracorPLANNING & DEVELOPMENT SERVICES
S - BUILDING & ZONING DIVISION
_ 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(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,
d Fe --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.
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 _ 1 3 —Z1
Permit Number: 2I I V —y Z G3
Site Address: ��ci1 3 o ec5rn, V K V-d Fo(+-p►-erce rc—
DQ r-Q-fsi Cis C o State License SLC License3x2a!!� _
Original GC, subcontractor or owner/builder /yam q
NC,� \rd, O O State Licensd l I�LC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reaso , which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be can Bed if work has been performed.
/> tL .119,1
SIGNATURE OF OWNER (or owner/builder) 4;NeM7MJF"NE C TRACTOR (or new GC. m applicable)
PRINT NAME Cl/�t/ AAJe1_ Jif PRINT NAME
State of Florida, County of St. Lucie County State of Florida. County of St. Lucie County
The following instrument was acknowledged before me this
Isrhday ofp� 2021. by 09,NAtQ Gwctli
who is personally known to me
has produced as In.
Signature of Notaryl Date
The following instrmment was acknowledged before me 1h�s
f Sin day ofw�.20Z1�by �t^i4�fGlCl O ��O
ho is pity ers.11, knowh to
V t�gy o(/ha�s/(pro{ducQe�d A as ED.
Signature of Notary ate
Revised 04/15/16 PSWV
NANCY HAGERHORST
Notary Public
State ofFlorida
Comma HH167992
Expires 8/23/2025
v1spol
NANCY HAGERHORST
_Notary Public
State of Florida
CorrlmaHH167992
'1xpira 8/23/2025