HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
�r BUILDING & ZONING DIVISION RECEIVED
OUNTY 2300 VIRGINIA AVE I
FORT PIERCE, FL 34982 UAR 16 2022
(772) 462-1553 FAX 462-15,78 Sty 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 tIo 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-
Contracto Wellon
CELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cof 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: �- L Z Permit Number: o`�d-02
Site Address: % 2.� M qrw bj,- - flille4l—C,
State License i SLC License
Original GC, subcontractor or owner/builder
State License I SLC License
New GC, subcontractor I
Reason for Cancellation L.o G� ` i S�0_c , 1i - a Q
The under igned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees om all
costs, f s or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
cont
on j tor/ subcontractor or � t Ration of permit. A permit cannot be cancelled if work has been performed.
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SIGNATU f�OZ ` R wnerY6uTlcrj" SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
A�day of Y"4,4 20aa , by E- Ua 1645--
who is personally known to me
who has Droduced - as ID.
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State of Florida, County 'of
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The following instrumenit was acknowledged before me this
day of 20_, by
who is personally known to
me or who has produced as L.U.
Signature of Notary i Date
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