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.
X 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.
7085piQ" CANCELLATION OF PERNUT — 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:
01/09/2017 Permit Number: 1707-0352
Site Address: 106 Spring Hill Dr. Jensen Bch, FI.
Harry Blue builders Inc. State License CBC1250529 SLC License
Original GC, subcontractor or owner/builder
Michael Blue Roofing Inc.
New GC, subcontractor
Reason for Cancellation Can Not Due This Roof
License SLC License 30082
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/subcontractor or cancellation of permit. A permit canno be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIMAM19 GENERAL
CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINT NAME I /#Ap/Y AL&6�
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20, by
who is personally known to me
or who has produced as ID.
01/09/2017
Signature of Notary Date
Revised 04/15/16
The following instrument was ackn wledged before me this
�n _day of -k V\ 20, by H a t c �
6 \ -% < who is personally known to
me or who has pr d�ucedd Ft- 0 L- as ID.
33 " . � 01 /09/2017
i