HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA- AVE L
EIVED
FORT PIERCE, FL 34982 2 2013(772) 462-1553 FAX 462-1578ty, Perm
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
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:
Site Address: 6 6 1/ or) W�f-ce- 2 1 vA ForT 1't`e r., FL 3�g i
�L my & P1?I e—it State License SLC License
Original dC, subcontractor or owner/builder Pt / r
�S� foA w0�` er State License �(�—IS1,5)SLC License
New GC, subcontractor or owner/builder
Reason for Cancellation C 6n4meyto r 0 (`j Li r-, ,
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 canno a ancell d if work has bee performed.
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SIGNATURE OF OWNER (or owner/builder) sidlkATiTRE G CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINT NAME. orx VV! IIe-/—
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this The following instr4ment was ackn ledg before me this
day of 20_, by 2 day of m" 20 by 0 W_K I1,01-
who is personally known to me
or who has produced as ID.
r i c,k wo\ I %C who is personally known to
or who has produced F4 O L as ID.
Signature of Notary Date Si n ary pEANNAifl§41e:apJldS E
�'�` MY CQMMIS51t5N ;# GG 022i1".'-}
Revised 05/18/2017 %TE o 8ondedlhrullotary�nSCcLft;Geryir,°A "