HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
+� BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772).462-1.553 FAX 462-1578
CHANGE OF CONTRACTOR. SUBCONTRACTOR OR CANCELLATION OF PERMT
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PLEASE SELECT ONE OF:TEIE FOLLOWING:
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CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
a d the new contractor of record for the current perrlTit. 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
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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. Thin: a is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBiCONTRACTOR -- Subcontractor changes are to be completed by the general contractor.
The new subcontractor must'fili out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLAT.ION;6F PERMIT — The cancellation of a permit is acceptable only if no work has been clone.
Cancellation of permit is't le signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.l;!
Date: 4/25/2022
Site Address: 203
Permit Number: 2202-0515
N DR FORT PIERCE, FL 34982
Original GC, subcontractor or owner/builder
MICHAEL C. PASTERNAK
New GC, subcontractor
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Reason for Cancellation
The undersigned does hereby a
costs, fees or damages arising4
contr,actodsubcontractor or can
License` SLC License
License EC13009713 SLC License
to indemnify and hold harmless St Lucie County, its officers, agents and employees from all,
any and all claims of action for any reason, which may arise as a result of this change of
ion of permit. A permit cannot be
cancelled if i • k has been performed.
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SIGNATURE 0FDANEtt (or own&butlder) SIGNATURE GENERALCONTRACTOR (or new GC, as applicable)
PRINT NAME Donald R. Hazellief _ Piui,41,JAME_ MICHAEL C. PASTERNAK
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State of Florida, County of St. Li
7hc following instrum nt was ac
25 aayoe >ri .21
or who has orcrliu:ed.
Signature
Rev
'ounty Slate of Florida, County of St. Lucie County
rled ged before me this The following im s ack Ictld,he nrr m tbis
byj � of cL _t2. 1 taLf 1�� tr 25 day of A"�`���' , zo ,, by lLCY;,�C . &2 kt r tnaK.
is personally known to nic ---who is personally known to
_as ID. me orcvhohaspmduced as
_ ( 4/25/2022
ate Signature or Notary Date
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