HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
- - 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 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.
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: f� — I1 3—Z I
Site Address: `O %c-1 —7
Permit Number::l I Z- 005 —7
i V J C 'I tq `ySC 0 State License SLC License
Original GC, subcontractor or owner/builder 2 -I
v State LicenseCC� �SLC 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, ee or damages tr' •ing from any and all claims of action for any reason, w h may arise as a result of this change of
.on ctor con c or or cancellation of permit. A permit cannot be cance0 it work has been performed.
GNA OF OWNS /ttor owner/builder) '/ 0111 ATUREC ��{{ /O�R(or new GC. as applicable)
PRINT NAME Q� LAL.iK PRINT NAME I 01U 6�1 U
State of Florida, Cowry of St. Lucie County
The following instrument was acknowledged before me this
1'Y~day of201�, by
��� Nhars personally )mow me
r t h has produced as ID.
Signature of Notary Dare
Revs /15"A"CY HAGERHORST
Notary Public
State of Florida
"-: Commp HH167992
�MCF tl�0 E>mires 8/23/2025
State of Florida, County of St. Lucie County
The following instrument was Sacknowledged before me s �)
\hday of�. 20�, by YGICTb 40
o is personally Imo to
m o has produced as ID.
5-
Signature ofNotary Date
WWCv KAGERNORST
�Wt Notary vublk
.v Stale of Florida
CernmF HH167992
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