HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SER ' ECEIVED
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE FEB 2 2 1-098
FORT PIERCE, FL 34982 ST. Lucie county, permitting
(772) 462-1553 FAX 462-1578 -- -
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,
an 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 signed by the general contractor only.
The new subcontractor must fill out a Subcontractor Agreement Form which is signed by both the contractor and
subcontractor. There is a $50.00 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: Permit Number: 1 71 ! — 66 /
Site Address:
IL
Leroy62nngH r State License SLC License
Original dC, sub11contrac6r or owneribuildner11
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M ]r (�c c'1 C 4 (�?nl) VV 1 IT State License C— C t .S % SLC License
New GC, subcontractor or owner/builder Reason for Cancellation (or4mcjrr OL� 0(�� _Z w n
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 ncel d if ork as been performed.
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SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL nCON CTOR (or new GC, as applicable)
PRINT NAME PRINT NAME�,Olft,?_
State of Florida, County of St Lucie County State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
day of 20_ by
who is personally known to me
or who has produced as ID.
Signature of Notary Date
The following instrument was acknowledged be re me this
day of ,�y 201L by�? g—J t t—
� '� %y who is personally known to
`,,me or who has pfo i d t- ` as ID.
Signature of Notary Date
Revised 05/18/2017