HomeMy WebLinkAboutCHG OF CONTRACTORF�cL�L�
M ., oc `MANGE OF C
_CHANGE OF'
and the new contractor e
contractor information E
--for job values greater
commencing any work.
>< CHANGE OF 5
The new subcontractor i
Contractor.
Cancellation of permit is
cancellation of the perm
Date:
Site Address: rn v
ST�✓�NE1J ,
Original GC, subcontract
N agjE E 64/
New GC, subcontractor
Reason for Cancellation
The andersigned dceshereb
costs fees or damageg arisir
Aontractorkubcontadctor oY
' SIGNAAIRE OF OWNER (Orox
PRINT NAME SrEPA/E
State of Florida, County of St We
MV
PLANNING & DEVELOPMENT S:
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
�rncs
URACTOR — Change of Contractor is to be signed and notarized by the property owner,
Ord for the current permit. A new permit application must also be completed with new
ignahae. A new Notice of Commencement must be filed in the new contractor's name
$2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
re is a S50.00 fee for the Change of Contractor.
:ONTRACfOR — Subcontractor changes are to be completed by the general contractor.
fill out a Subcontractor Agreement Form. There is a S50.00 fee for the Change of Sub -
..
OF
OF PERMIT — The cancellation of a pemrit is acceptable only if no work has been done.
be signed and notarized by both the owner and qualifier of record. There is no fee for
Permit Number.a O 1 —0 7 i 7
License SLC License
License�5 42LC License,.,
to indemnify and hold harmless St Lucie County, its officers, agents and employees from
any and all claims of action for any reason, whir ay arise as a result of this change of
Lion of permit A permitnnnot be eft"lleffillArork has been performed
der) SIGNATURE GENERAL CONTRACTOR (or nnewW, as applicable)
EJ?RE/e/1 PRINT NAMEe HR I S� ,E rl /GAj A(r
State of Florida. County ofSt. Lucie County
personally (mown to me
ublic
aiV
�G Notary Public State of Florida
Zn 2 22 :P Kaylin J. May
My Commission GG 90a961
ar^ Expires 101032023
�x
_CHANGE OF
and the new contractor t
contractor information
ibr�ob values greater
CHANGE OF
The new subcontractor
Contractor.
Cancellation of permit is
cancellation of the perm
Date: 5 — 2 3 !
Site Address:
Original GC,
New GC, subcontractor
Reason for Cancellation
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
VTRACTOR — Chan# of Contractor is to be signed and notarized by the property owner,
ord for the current i it. A new permit application must also be completed with, new
ignature. A new otice of Commencement must be filed in the new contractor's name
$2,500 00 if A/C Change -out). A recorded copy must be submitted prior to
r s a $50.00 fee for the Change of Contractor.
--ONTRACTOR — Subcontractor changes are to be completed by the general contractor.
fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
be signed and notarized by both the owner and qualifier of record. There is no fee for
Permit Number: o I --o 7
License � SLC License
Licens PC 1 yS?_5rLC Licg44e �
The undersigned does hereby, agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising1from any and all claims of action for any reason, which may arise as a result of this change of
contracto subcontractor e2a�ncellation of permit. A permit cannot be ancellled�iiff work has been performed.
SIGNA OF O_WNER(or owne1rfbuilder) S ATURE GENE CONTRAC (or new GC, as applicable)
PRINT NAME STt P4,E j J,ERRE/rBA PRINT NAME
State of Florida, Canary of St. Loci County State of Florida, County of St. Lucie County
The following instrument was acknowledged �bowas efore me this y�( �p, The following instrument acknowledged before me this
y of .2o�' 0-1 0vl d �r ��day of �I >a y .20 Z by �0/JN M • inA
[who
r7is personally known to me who is personally knowplQ
&Zhs,has woduced as ID. me or who has oroducgd as ID.
alarv(� (Date Sig`natture of Notary { Date
Con o/ F/o� V•Q (j /!/M 1� �Gt�L6s ✓f a Y'.
My ��p���Sgs;c�ad-Nar�NN �+
"'oe� °� Fk7j0�)giic gY w am Henry Donovan jr
P ?02�iros pia Expves 041 25.O8M57
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