HomeMy WebLinkAboutChange Of ContractorPLANNING & DEVELOPMENT SERVICE
BUILDING & ZONING DIVISION K�
2300 VIRGINIA AVE RECENED
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 NOV 0 12017
PERNUTTIPIu
St. Lucie Coi;nty, F!
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
co ncmg any work. There is a $50.00 fee for the Change of Contractor.
,61&GE`OF�SU&C-O TRACTOR -Ail 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.
CANCELLATION OF PERIVIIT — 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: 11- 1 11
Site Address: / Z
Reason for Cancellation
4 r0mu
owner/builder
Permit Number:
License SLC License
0ls
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/subcontractor or cancellation of permit. A permit cannot be cancelled if work has b n performed.
,S}6KATURE OF WNER or vGtier/buitder) SIB# ATURE GENE ON CTOR (or new GC, as applicable)
PRINT NAME PRINTNAME
State of Florida, County of St. Lucie County
§e lowing instrument was acknowledged before me this
da) of a by
o is personally known to me
4ig
ure of Notary Date
RIANA DOOM
Revised 04/15/16[Notary Public, State of Florida
Commission# GG 126668
comm. expires July 20, 2021
State of Florida, County of St. Lucie County
The following instrument was acknowledged of .re me this
day of OC�h et . 20�y
Mur& c, who iF6etsonally Imo 0
me or who ha produ ed 4 as 19.
Signa of Notary Date
KAYLA SHORT
itNOTARY PUBLIC
, STATE OF FLORIDA
Comm# FF171393
Expires 10/23/2018