HomeMy WebLinkAboutChange Of ContractorPLANNING & DEVELOPMENT :SERVICES
BUILDING & ZONING,I➢IVISIO.N
' 2300: VIRGINIA AVE y R EC I11:
FORT PIERCE, FL 34982
(772) 4624553 FAX 462-1578 M A R 2 0 L,918
S7. Lucie County, Permittin
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 S50.00 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:i (-I I g
Site address: 1 *%0_'�b 15 13
Permit Number:
56 W "N' H� a WU > State License D I 31 SLC License Original GC, subcontractor or owner/builder
41 AM A-L,1 EZ p iZ7M
State License__ 3a? $ SLC License 3p
New GC, subcontractor
Reason form Q>0. , MA A;(,-
The undersigned does hereby agree to indemnify and hold -harmless St Lucie County,
costs, fees or damages arising from any and all claims of action for any reason, wh ch may officers,
se as a result of this change o all
contractor/subcontractor or ancellation of permit. A, permit cannot be cancelled if work has been performed.
IGNA URE OF Wwn
NER (or oerLbuilder) StGNA RE GE\ L CONTRACTOR (or new GC, as applicrble)
GRIN NAME— i i�i�� � r �
I RINT NAbtE
State of Florida_ Comity of St. Lucie County state of Florida, County of St. Lucie County
The following insfrument was acknowledged before me this
LO day of �/V\ 20_& by
00A 1ff 01 M n(lt f vt,o i ersonally known ome
who has p luced as ID.
Sign re f Notary Date
Re8EMILYGALEN
'MM1$SION $0016546'
2
S0eemarlEXPIRE2021
} OWWThN Notary Publlo Untleetwtitm
The fallowing ' �.�.meeryyn��t�N%ms acknowledged before me this
day of � .�cc -. 20 jl. by
(1't2lt uLZ Pb t��W_65� _: who is!rsonally know to
me or vho has produced
Sig tore of Notary UDate
MELISSAS.VOIGTSBERGER
t+: MY commissiON # GG 09176i
EXPIRES: April 9, 2021
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'•: gF; Bonded Thru Notary Public Urder+eitiets