HomeMy WebLinkAboutChange of ContractorI
j RECEIVED
Planning & Development Services b MAR 0 5 2018
Building & Code Regulations Division
2300 Virginia Ave. ST. Lucie County, Permitting
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
PLEASE SELECT ONE OF THE FOLLOWING:
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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 mast also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in ithe new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy mast 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 mast fill out a Sub -Contractor Agreement Form. There is a $50.00,1fee for the Change of Sub -
Contractor. '1
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. i i
Date: a-•f 1 8
Permit Number: 17 /111-
T�• ; �I
Site Address: R-3O9 )00rt,51OL 4�r f p 2 T tD, - L-- aC E L
U State Licenseew/a,�/ZZY SL , License
Original GC, subcontractor or owner/builder r/
BU1'� S � "Q O-RA NOAVISState LicensZ&10G/o2�si' SLC License
New GC, subcontractor it
Reason for Cancellation
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/subconttactot• or cancellation of
permit. A p mit can of be cancelled if work has been perfqrmed.
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SIGNATURE O�F OWNER (or owne�iider) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME^- `�i _ PRINTNAMETT--
State of Florida, County of St. Lucie County
The following instrument was acknowledg d before me Chris
all_day of — , 20[g. by 1
who is iersonally know to me
or wh a roduccd as
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State of Florida, Counry of St. Lucie County
The following instrument was acknowledge(
97 day of _, 20l d , by
or who
e-,n n the,wY
know to me
Signature of Votary ! Date i1
2olt�;t,°ueeo RHONDASROWE
* * commission # GG 104656
N oQ Expires May 19, 2021
9rFppiF�oQ� Bonded Thrdi udget Notary Services