HomeMy WebLinkAboutChange Of Contractor_46
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 JUL 0 6 2018
(772) 462-1553 FAX 462-1578 ST. Lucie County, Permitting
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 -
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: J i vt $
Site Address: 13(b l.ax.z q,, _e L)Y J'e,
Permit Number: 1-710 - O 1 3 S
C& Sho YL� 44 -04 I(kc- 4 State License F_- SLC License I o 2. 8
Original Gt, su contracto, owner/builder
st-I"c,-c. State License
New GC, subcontractor
Reason for Cancellation Rootf c% ct, n tot, ak*cr 1 c>&; 4
License C C C- 13 3 08 l b
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 cancelled if work has been performed.
SIN RE OF OWNER (or owner/builder)
PRINT NAME IjVatf,
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_VWay of Jwi 20L6_ by
C who is personally known to me
or who has produced f 1. D (-- as D.
Signature of Notary KA R E N S. N 1 E L S E N
C-:State of Florida -Notary Public
Commission,# GG 207484
Revised 04/15/16 My Commission Expires
June 12, 2022
SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_, by
is personally known to
me or who has produced as ID.
of Notary Date
..t
PERMIT # P7 I D — DI 3 5 ISSUE DATE
1-
PLANNING'& DEVELOPMENT SERVICES
Duilding & Code Compliance Division.
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
� V EZU
JUL 0 6 2018
ST. Lucie County, Permitting
St.'Lucie: Roofing
have agreed to be
(Company Name/Individual Name) Heritage Contracting. Services Inc,.
the Roofing Sub -contractor for
(Type of Trade) (Primary Contractor)
For the project located at 1316 Lone Pine Drive Ft. Pierce FL 34982
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding. our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
f�� 7/3/2018 11:30:28 AM PDT
I
CONTRACTOR. SIGNATURE (Qualitier)
Paul Kuhn
PRINT NAME
CGC 1507158
COUNTY CERTIFICATTONNUMBER
c
State of Florida, County of ,A . U., p— a
t;
The foregoin0pstrument was signed before me this day of
20 � byQ�)P�
who is personally known or has produced a pet-4t,{5 \Acet- e
a identification.
L\\Q,o--
S'gn tore of Notary ubGc
Print Name of Notary Public
pwon=::_
SUWCONT _ ACTOR SIGNATURE, (Qualifier)
—1?f-cc-i y HGm�sac�
PRINT NAME
C cc 1330g (kp
COUNTY CERTIFICATION NUMBER
State of Florida, County of l+ • Lu G Az—,
The foregoing instrument�)%yas signed beform e me this
day of
J , 20 by �.1 C P&l
who is.personally known or has produced a
as identification.
STAMP PV51
Signature of Notary Public
i
Print Name of Notary Public
JENNMHORTON t CONSTANCE PROULX
YKCaDMAfS�ON�OG1S9000
MY COMMISSION # FF 160517
Revised 11/16/2016 0(P'iF0�f1111y��i�i ���Qy EXPIRES September 16, 2018
i0fId14�1y{I yA%I�C 4D7 399.0163 Fbigallota Servtoe.nom
STAMP