HomeMy WebLinkAboutChange Of ContractorV,
FLANNJNG & DEVELOPMENT SERVICES
RLTILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 4//�/y/
62-157$(�
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CHANGE OF CONTRACTO SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING_
_CHANGE OF CONTRACTOR — Change of Contractor is to be sipied and notarized by the property owner,
and the new contractor ofrecord 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 op 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 actor.
CANCELLATION OF P1ERIMT — The cancellation of a permit is acceptable only if no work has been done_
an ellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no Pee for
cancellation of the permit.
Date: L /; :
Si'teAd�dress: -56?dl #eoij�wi6( ; La
State
Original GC, subcontractor or owner/builder
Permit Number:
r�
_ r .
License
State License _SLC License
New GC, subcontractor
Reason for Cancellation N UJV "
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 cannot be cane sled if wor has b en performed.
51GNA'fURE OF OWN> R (or ownCr/builder) SIGNAT[J Al. CbNTR/1CT01t (or w G, s ble)
PRINT NAME PRINT NA
State of Florida. County of SL Lucfo County State of Fiorirla, County of St. Lucie County
Tile following instrument was acknowlodged before me this 1 lowino i ment was ckn edg rem this Q %+a, f�
day of __ 20_, by _ day of o
who is personally known to me hp is personally known to
or who has produced as 11), or o s ID.
did ► `�
Signature of Notary Date Sion ee of Notary Date
y YANIRA J. PENA SAWIAGO
NOTARY PUBLIC
Revisoo 04/15/16 STATE OF FLORIDA
t bComm#G0178726
�� Expires 5/19/2022