HomeMy WebLinkAbout Change of Contractor i
JAN 0 5 2022
St.Lucie County
PermiVEANNING&DEVELOPMENT SERVICES
Llli c BUILDING& ZONING DIVISION
• k_ 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,
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,
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: 1/4/2022 Permit Number: DZq
Site Address: J`^310 SaAn P lone . FDV-V-
P�erce
Ridgeway Plumbing Inc. State License(i�101 U) _'SLC License
Original GC,subcontractor or ownerlbuilder
Benjamin DreWs Plumbing&Drain State License CFC1429456 SLC License
New GC,subcontractor R(�
Reason for Cancellation unable to complete job
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 reason,which may arise as a result of this change of
�I,cnrt r subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
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SIGNATURE OF OWNER(or owner r SIONATURE GENEE� CONTRACTOR(or new GC,as applicable)
�f PRINT NAME hWan �s PRINTNAME f `&rAn%n n1 —2
State of Florida,County of St.Lucie Comity State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this Th f(lowing i tmment was acknowled ed before me this
—t • day of ,20 Z byW. day orr 20 Z2,by��n
�A VI WMS Who is personally known to me t hC� n«. who is personally known to .
or who h s produced as ID. me or=.uced_ as ID.
1/412022 1/4/2022 ;
Signature of Notary Date Signature of Notary Date
IM4
�ar"i ANGIE PERDOMO
Revised 4{„� b, ; Notary Public•State of Florida
v � • ANGIE PERDOMO
?Q• Notary Public State of Florida I commission k HH 47988
�� Commission t HH 47988
,oFr my Comm.Expires Sep 29,2024
.,� o�'.�' � '"Bonded through National Notary Asti,.
of fl, My Comm.Expires Sep 29,2024
Bonded through National Notary Assn. !
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