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: d-,20ZZ
Permit Number: I
Site Address: '5-Zo l �} 1-�� �t ►J�� t2G► �r �t�, '� �v �-�
License SLC License
Original:GC, subcontractor or owner/builder
License SLC License
New GC, subcontractor
Reason for Cancellation S o
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
coacto tcellation_ of permit. A permit cannot be cancelled if work has been performed.
c f-
SI ATURE O NER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME 4fl01'5 PRINT NAME
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 acknowledged before me this
day of, 201 b�i�._ day of 20_, by
i
�5��• who is personally known to me who is personally known to
or -who has produced VL as ID. me or who has produced as ID.
INA
kiA.Y.re of Notary a e Signature of Notary Date
LASHAHNAINGRAM•RAHMING
MY COMMISSION # GG 275060
Revised 04/15/16 s'; o�' EXPIRES. December 20,2022
Bonded Thru Notary Public Undelwdtem