HomeMy WebLinkAboutChange Of Contractorr porl -oags
PLANNING & DEVELOPMENT SERVICES R�o
BUILDING & ZONING DIVISION Mqy
2300 VIRGINIA AVE perT/4.10 ®� �1B
FORT PIERCE FL 34982 St 4oeeC`tr
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oj�n� eqt
(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 $50.00 fee for the Change of Sub-
C tr ctor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date:
I Permit Number: C7-w-4� Site Address: � � �-once u)ood
License SLC License
Original GC, subcontractor or owner/builder
License SLC License
New GC, subcontractor
Reason for Cancellation C�-D --Ac(Y\ed� L�R�` CO(��ir�c�
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a r t of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelledjf wor�as b performed.
SIGNATURE OF OWNER (or owner/builder) SIGNA'1lURE Ct�NE�' — L V�RA���GC, as �ljcable��r�' u--�`�
PRINT NAME PRINT NAME_ '(��JL
State of Florida, County of St. Lucie County State of lorida, County of St. Lucie County
The following instrument was acknowledged before me this e 1 i inm a ac ged of e m .
day of 20� by day of , 20 by ie ` �l 0
oj
who is personally known to me w o is personally known) tW_IL�
or who has produced as ID. �Q%t%M p �$I,bj��produced11dQ sIDC)I ` O�
Signature of Notary Date k19Ytfa� Date
N0TARy . SS U
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Revised 04/15/16 1A't•O PUB LI
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PLANNING. & DIWELOPA
BUILDING & 7 4FNT SERVIC-P-S
230
. 0 VIRGINIA AVE
FORT "'F-RCE JFL 34982
(772)462-,
VAX 462-1578
PM
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OF rONTRA
-and tF)c jzewemtr CTOR — (-h
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"IfOMWOn and orate cur et Pmrft A new. pevgf
for job val 5TWUM A MCw Notice 1j,Mian most alqo be
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�—CANCRLWJON OF PERN11T. -nze
(�Inc daiiian of Perim, mnCOW9264un iora PQ7131t
f is 1.0 be SJrMCd and Aotirized - by bk1th the 93 aCceptable only if no wGrk. Im bft )Re.
M.13CEnAtion,of like permit, Rfld qLmli;ffcr otTecOrd- There i 3 no dire for
Permit -Number.,
-Site Addrm:
U _ T' i _W2
Reason far Cueelly&A
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PRWA NAME
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JENNWER'CORSON
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Expires October 30, 2021
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Communication Result Report ( Dec. 8. 2017 8:1.9AM)
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Date/Time,�,Dec, 8. 2017 8:18AM
CO
File Page
No. Mode Destination Pg(s) Result 1 Not Sent
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0287 Memory TX 4621578 P. 1 OK /
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