HomeMy WebLinkAboutChange of Contractor I I
PLANNING & DEVELOPMEN
"leEIVED BUILDING & ZONING DIVISI
2300 VIRGINIA AVE
JUL 19 2018
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-15,78 Permitting Department
St. Lucie County, FL
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
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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 $50.06,fee for the Change of Sub-
Contr ctor.
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: O?/ / Permit Number: :5;2(�
Site Address: IY29 /COY
State License 42L/33o8 SLC License
Original GC,subcontractor or owneribuilder
State License SLC License
New GC,subcontractor
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Reason for Cancellation 4:5WAwCE
TlIe 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 re on,which may arise as a result of this change of
contractor/subcontractZorcellation of permit.A permit cannot be c ork has be in performed.
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SIGNA OF OWNER(or owner/builder) SIGN GEI�' ONTRACTOR(or new GC,as applicable)
PRINT NAME Cr %Cif y �fJ Lf/s PRINTNAME GU%S/y .f�9 /i✓�I�
State of Florida County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was aclno kedged before me this
day of -e Wl 20�by _day of emu/ 20L7by Wl,-&
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who is petsonally known to me who is pe,sbnally known to
or who has produced as ID. me or who has produced, as ID.
a l IS a 37 9
Signature of Nq P ��%; Commission >f FF964172 Signature of Notary ++, DateE ,rnanpelie Pisrre-i.0U1S
_�� g ....
�i�` Commission # FF96072
; Expires:February 24,2020 �+_ .February 24,2024
Revised o4/ '�,, n .�' Bonded thru Aaron Notary ' - Expires
Bonded thru Aaron Notary
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