HomeMy WebLinkAboutChange of Contractor-CHG SUB -OWNER BUILDERPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 ;
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CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF TFIE FOLLOWING:
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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
i cor Vcing 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.
CANCELLATAO,%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
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cancellation of theRprt 2022
St. Luci�jCounty
Date: Per6tting Permit Number:
Site Address: �� I �C ee ! )p �Y� i_ .
State License SLC License
Original GC, ubcontractor or owner/builder
I State License SLC License
New GC, subcontractor I
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Reason for Cancellation
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The undersigned does
costs, fees or damages
contractor/subcontract
reby' agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from
isitig from any and all claims of action for any reason, which may arise as a result of this change of
or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owniedb�uild[er) /
PRINT NAME / `�i�Jl/�5i/ /7 �� ��✓
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State of Florida, County of St Lucie County
The lllowing instrument was ack noowwlledged before me this
1 0 day of 2C1`� ,ley- /�
4o is personally known to me
i or who W prWuced-L_b_....as m.
Signature of Notary
Revised 04/15/16
U N1;RAL CONTRACTOR (or new GC, as applicable)
PRINT
State of Florida, County of Iskulcie County
,The following instrument was acOhkledged before me this
day of 20^
who is persona own to
me or who has produced as ID.
Signature of Notary
state ofCoN V ...
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Date
PERMIT #
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
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Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
(Company Name/Ind111p(�00'13ub-contractor
&a Name)
the for-
.
(Type of Trade) (Primary Contra tor)
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For the project located at 1:
(Project Street Address or Property ID )
It is understood that, if there is any change of status regarding our participation with the above mentioned 1
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
j filing of a Change of Sub! contractor notice.
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CONTRACTOR SIGNATURE (Qualifier) SUB-C NTRACTOR SIGNATURE (Qualifier)
PRINT NAME PRINT NAME -
COUNTY CERTIFICIATION NUMBER COUNTY ERTIFICATION NUMBER.
State of Florida, County of _(.� State of Florida, County of S L4,t_c4_.
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this R-day of
20 "�by Q1 "SQ h L�OA�V1 ; 2P , by
who is personally known _or has produced a _L [1 who is personally (mown _or has produced a
as identification. as identification.
STAMP � STAM1
Signature of Notary Public Signature of Notary Public
Print Name
t! GLEN =•=sratoE�FEN V V
Co of Flor VA(/G 9 G of Lori 'q , GH
4,,o i��p��•` A9 rnrnissio Ada-NotarHN %;, y0;` Mmmisslon # Notary P
Y,C n YP °inii`
om GG �blic Y Corn GG 27 Public .
Oct missip 2�p07 Octo mission E Op7g
Revised 1 t/16/2016 obey 22 2p�2ires9 bef 22 .202� res
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