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'LANNING & DEVELOPPA
h' UILDING & ZONINGD11VISION
O. .,I ERCE, FL 34982
(7 / A) �1U2-1553 FAX 462-1578
CHANGE OF COI�1� 1[�AC t ®ll�,�11�C®lei loci TOR O>3 c�Al�1cCE1LlI A t ><ON ®' l�'{ l[�I`Vi[T
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.
°''p CAN4"ELLATI®1`V ®F 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: 2/11/2022 F�P�'anit NL>luu�Poel,': 2110-0347
Site Address: 234 BIMINI DRIVE
WILCO CONSTRUCTION INC.
Original GC, subcontractor or owner/builder
License SCC131151026 SLC License 29115
State License SLC License
New GC, subcontractor
Reason for Cancellation PROPERTY WAS RECENTLY SOLD AND PROPERTY OWNER WISHES TO CANCEL /VOID PERMIT
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
contra ctor/s contractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME ROBERT WILLIAMS
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
11th day of Februa
20 2�
who is personally known to to
i ►ral1� Ir ' t
Signature of r Date
DAWN FITZGERALD
Revise Q�1"1 '., i MY COMMISSIONI'f �{ 167455
F�CPIRES: December 17, 2025
'• oF.�)°,". WAW TW Notary Public UAefwy#&
PRINT NA
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
itlh day of February . 20_, by
who is personally known to
me or who has produced as ID.
2/11 /2022
Signature of Notary Date