HomeMy WebLinkAbout Change of Contractor JAN 0 5 2022 '
St.Lucie County
Permitting
{ s> ---------- PLANNING&DEVELOPMENT SERVICES
.I `+ BUILDING& ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERNIT
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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$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
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Cancation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for E
cancellation of the permit.
Date: 1/412022 Permit Number: 210 LP' D109
Site Address: 18' SGL,In -F + �(ice I-C
Ridgeway Plumbing Inc State License �1��77SLC License '- G 54
Original GC,subcontractor or owner/builder
Benjamin Drew's Plumbing&Drain State License CFC1429458 SLC License
' New GC,subcontractor
j Reason for Cancellation I unable to complete job
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The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs;fees or damages arising fiom any and all claims of action for any reason,which may arise as a result of this change of
contractor/subc tr-setar or cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or;owner/builder) SIGNATURE GENERA TRACTOR(or new GC,as applicable)
PRINT NAME-f Nd 1 wamJ PRINTNAME�Q'1J0L ;n 0Z A-Y'C t 'Z
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The fgilowing instrument was acknowledged before me this Thg vlow,ng inst ment was acknowledged before me this
r��=deyof�,, ,20z2,by _ ` '¢dayof20� �,�n,by :f1
13Y��A1� ►�GlQltrtS who is personally known to me �t 40C 7 who is personally tuioan to
or who has has pr , as ID. me or who has produced as ID.
114/2022 1/412022
Signature of Notary Date Signature of Notary Date
'""�'�'�' ,fie ri;•. ANGIE PERDOMO
Revised 0 } r �e•. ANG1E PERDOMOt$ fir' Notary Public-State of Florida
� Notary Public-State of Florida �' Cotnmisslon 9 HH 47998
' Commission rk HH 47988 'N KV My Comm.Expires Sep r9,2024
of My Comm.Expires Sep 29,2024 Bonded through National Notary Assn,
PEded,through National Notary Assn.
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