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 — Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of reco d for the current permit. A new permit application must also be completed with new
contractor information and sil nature. 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. Ther is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBC )NTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must f II out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION 0 F PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to b signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 2 Z ` Permit Number: Z 0 2-
' D •5 ` 9
Site Address: -1 1'yt r V 2
State License SLC License
/O'r�iginal GC, subcontractor o owner/builder
L-. State License P-6(-&l 3 344LC License
New GC subcontractor a
Reason for Cancellation Ae 1,e L-J i—a t W
The undersigned does hereby ag a to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising fro any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cant Ration of permit. A permit cannot be ceBed if wor has been performed.
SIGNAIVRE OF OWNER (or own erPo ilder) IGN GENERAL CONTRAPkM (or new GC, as applicable)
PRINT NAME PRINT NAME y j „� L - ��� r-1111—
State of Florida, County of St. Lucre Cot ray State of Florida, County of St. Lucie County
The Mowing ent was aclmowle ged b1fore me this The following r t was ac f e me thi ge ^
day o . 2glk G 0 day oP -.. 2 y
weehooS i, rsonally own to in who is personal) known 1J
or who h uc 16 �' 1 G me or �Qaasprro-d�u'ce�d T� as
Signature of Notary Dat Signature of Nan" V D.te
AODREY B. 14UMPHFtEY AUOREY B. HUMPHREY
Revised 09/1 - fj�'-: ', MY COMMISSION8GG 300817 >t G300Z I';i
—AUOREY 6.F %IPHREY h _ MYCOMMISSION.G
" GG 3008W ,,y `j EXPIRES: March 6, 2023 EXPIRES: March 6 20 3
I ' M1'COMMiSSIO R — [;ended Thru Not
Public UnderNtaere t. Fublic Uid re �_r'-
F�(PIRES: M rch 6.2023 ,,I,r,ded Thru Notary _
+. unlit Undenvraers —�---- '
.e , f.unded Thru Nolary — •'=-J'