HomeMy WebLinkAbout Change of Contractor i
i Iron PLANNING & DEVELOPMENT SERVIG§`� o/ak,a�
- -� BUILDING & ZONING DIVISION
® o 2300 VIRGINIA AVE �.� ®4 1,
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING: 'D
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
i 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. j
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-
Con actor.
CANCELLATION OF PERNHT—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.
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r Date: 2 eP rmit l um eb r:
P♦am rr O!ft
Site Address: K rL .A2N Ey 49E
KPWOOD 81214 IT PrFWFL State License SLC License
Original GC,subcontractor or owner/builder
s
State License SLC License
New GC,subcontractor Cs-rm-e OTtJfje i ru Ft02/►1l WWO PAo V i AEb)
" Reason for CancellationCezrwim pro Nor U/A471 TO .910P/DIF-1105 $Mp,LL jp
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
contractor/subcontractor or cancellation of pe t.A permit cannot be cancelled if work has been performed.
SIG TURE OF OWNER(or er/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME W t w^m P' Ryemek PRINTNAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
JThe following instrument was acknowledged before me this The following instrument was acknowledged before me this
i by i l day of 20_,by
E L L E N VA U G H N,w ersonally]mown to me who is personally known to j
o'P�Yr`8 State of Floma- otary ubIIC
fir v ft�ngg4 me or who has produced as ID.IM
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Q� My Commission Expire
OF FtO s f
gna ute oMMfai` — -- — e Signature of Notary Date
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