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,
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: 2 S/22— Permit Number:
SLC- —2to-7, —a33rD
Site Address: 5l e1 �r�� i an Se_fA L Pi , 'FL Rear— , F'L. 3Lj° 6
J4M05 fl. 61-Ann C-rhe- Porch 169610 State License SLC License 26706
Original GC, subcontractor or owner/builder
JY1gri o RLA.55c7
State License SLC License
New GC, subcontractor 1 - ^ _ 1 I
Reason for Cancellation T p M V l o�S CO�aCI - �; � ��71 � ►\,y' &aAy- �
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and -employees from all
costs, fees or damages arisin& from any and all claims of action for any reason, whi may ' e as a result of this change of
contractor/subco actor or ancellation of permit. A permit cannot be cancel o a een performed.
sI ATURE OF OWNER (or owner/builder) SIGNATURIf GENERAL C CTOR (or r 96C, as applicable)
PRINT NAME Kober + E. 44w)�
State of Florida, County of St. Lucie County
The following in trument was aclnowl d before me this
e:D. Sday of 20 �1 b�
I ►QA-#e who is personally known to me
2Vto has produce_dQ L As D.
Signature of Notary Date
Q�RAHMING
Revised 04 YP'•s SSIO G275060
° mbet 20, 2022
Fo'dF °`�, Bonded NotaryPublicUndewfiters
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PRINT
State of Florida, County of St. Lucie County
The following in ment was acknowledged before this
aTday of 2QL by''�tllGa .a , "
who is personally larown to
or who has produced as ID.
Signature of Notary Date
LASHAHNAINGRAM-RAMMINGA
«: «; W COMMISSION # GG 275060 1�
eo EXPIRES: December 20, 2022
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