HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES-.
BUILDING & ZONING DIVISION
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2300 VIRGINIA,AVE RECEIVED
FORT PIERCE, FL 34982
FEB 07 2022
(772) 462-1553 FAX 462-1578
St.-Lucie County
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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-
Con or.
Sub-
Con OF PERNIIT—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: g' --�— _ 9/O G3SS
Permit Number.:
Site Address: Q t/ /.),r l vr
VP State License SLC License
Original GC, subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation_JV0%1,�,,I;I>i ice,
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 or7cellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
)
PRINT NAME ✓r^i C-c/'-- PRINTNAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
day of S-_� 2(��byJr-.�� day of 20—by
— who is personally known to me who is personally known to
r who has produced w°Pt �as ID. me or who has produced as ID.
Ab
Sig tT�jg#r,ptary DEANNA G14fi* Signature of Notary Date
x°• �r , Notary Public•state of Florida
�g. Commission;HH 086359
oFn My Comm.Expires Jar 28,2025
Rev' ecl""0Agol&{dthrough National Notary Assn.