HomeMy WebLinkAboutChange Of ContractorM
Planning & Development Services RECEIVED
Building & Code Regulations Division
2300 Virginia Ave. MAR 0 5 2018
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578 L
Lucie County, permitting
PLEASE SELECT ONE OF THE FOLLOWING:
V! 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 trust 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 trust 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 Sub -Contractor 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: 09-• a-71 / O Permit Number: 174o7- ��(q 7
Site Address: 9,3.38 13P-F.A1-'->✓n�s ROL,) 2T Pt eaL-r-- FL �34 �
Kenor (9&AV-(Ajo I I J State License69CUTAZ 9-Z SLC License
Original GC, subconj-actor or owner/builder
Rfta PJtltleRfS LLL VIPA"t Ar'S State License�&[@. ;QQ' SLC License
New GC, subcontractor
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/subcontractor or cancellation of
permit. A permit of be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) {� SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME I—IS;9 jRL—r0 PRINT NAME _ �wI 4' b6YL&_:g--7
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
JJ_day of 20 /F by �S-q 1�ICL
who is personally know to me
or who 1 s oduced
a I[
signature of Notary
Date
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RHONDASROWE
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Commission # GG 104656
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Expires May 19, 2021
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State of Florida, County of St. Lucie County
The following instrument was acknowledged kefore me thi
day of /, 20 �t� byGihil'1 I
who is personally know to me
or who a p oduced as ID 7
Signature of Notary 511&
RHONDAS ROWE
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Commission # GG 104656
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Expires Mey 19, 2021
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