HomeMy WebLinkAboutChange of Contractor i
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
• 2300 VIRGIN AVE REcEivED
IA
FORT PIERCE, FL 34982 FEB 19'2022
(772) 462-1553 FAX 4.62-1578 St-Lucie County
Permittino
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-
Co t ctor.
CANCELLATION OF PERAUT—The cancellation of a permit is acceptable only if no work has been done.
Cance ation 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: Permit Number:
Site Address:
_
F G ( Ho(re____Pr-,W=c-{f e'_S LNe- State License SLC License
Original GC, subcontractor or owner/builder
State License CCCA ZL- J 573 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 ges arising from any and all claims of action for reason,which may arise as a result of this change of
;,,,ntracto be�ntra for or cancellation of permit.A permit can t b Cance if wo has bee ormed.
NAT/URE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME�(� t�(�_ f� PRINT NAME`
IPf I� cn� (f'7
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 ins ment was acknowledged before me this
f'� f'L1rrI 20' b _day of 2i by
�c7 day of U y `
yGile�fit�i�7CCiCS�LS who is personally known tome 1 fAl o is ersonally known,to
w has pro ed �� as ID. me or ho e as ID.
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Signature of Notary Date gnature of Notary Date
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DAN1E:EDDIN
'o ? JULIE ANNE CARREIRO
Revised 04/15/16 � NotatyPubli ? ;;Commission#GG279786
l ommlSsloExpires December 7,2022
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