HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE I RECEIVED
FORT PIERCE, FL 34982 MAR 15 2022
(772) 462-1553 FAX 462-1578 St. Lucie County
Permitting
F PERMT
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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. 1
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be compl
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.0
Vontractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable c
a cellation of permit is to be signed and notarized by both the owner and qualifier t
cancellation of the permit.
Date: Permit Number:
Site Address: 9710 . 0_ -4o aq RD P4 r 1` l .'On e
/✓ r_a�(),i1Q� �� IAliii� %o State License
Original GC, subcontractor or o ner/builder
State
New GC, subcontractor
Reason for Cancellation
A by the general contractor.
fee for the Change of Sub-
[y if no work has been done.
record. There is no fee for
a �
C License
,C License
`NI � ►/Iy��I �ril.r�lll
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/subcontr ctor or cancellation of permit. A permit cannot be cancelled if work has been performed. 246
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SIGNATURE OF OWNER (or owne /bui / r) V SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME rl��, Aq0 & h�t�)
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
IJ day of CL f 20 by
C� �� 1 �o►'�� 1GLfd who is ersonally known to me
r o has prod i \V e�SL` as ID.
Signature of Notary Date
� P Notary Public State of Florida
Revised 04/15/16 :° Amanda Richardson
_ My Commission HH 020206
Ex ires 07119a024
P
PRINT NAME I
i
State of Florida, County of St. Lucie County
The following instrument was acknowledged) before me this
day of 20_, by
who is personally known to
me or who has produced as ID
Signature of Notary Date