HomeMy WebLinkAboutChange Of Contractorj
PLANNING & DEVELOPMENT "'Ei-
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE, sr
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLEASE SELECT ONE OF THE FOLLOWING:
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. 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.
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: / D
Permit Number: a
Site Address: cl a `7 S 2 & OC,K S m 1' 410 Q, Ci
� IR- Elk( Ar 1 C- State License SLC License
Original , subcontractor or owner/builder
State License SLC License
New GC, subcontractor
Reason for Cancellation ugh Q-hd 1^1 0
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
co a or/sub ontra r or cancellation of pe t. A permit cannot be cancelled if woyk has en formed.
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SIGNA OF O (or owner der) p SIGNAT[JRE YEITEW C OR (or newGC,a/g applicable)
PRINT NAME Q.� �� 11�Y�OA�'i PRINT NAME 0,_X f fyl�
State of Florida, County of St. Lucie County
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State of Florida, County of St. Lucie County
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