HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(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,
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 $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: 10/18/2017 Permit Number: I 7 a 0 J kC-,vW- q 0
Site Address: 10725 S OCEAN DR LOT 287
TOMS MOBILE HOMES State License IH1118467 SLC License
Original GC, subcontractor or owner/builder
ANCHOR DOWN MOBILE HOMES State License IH1101137 SLC License
New GC, subcontractor
Reason for Cancellation SCHEDULING WORK LOAD
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
contraac /subcon for cance tion of permit. A permit cannot be
cancelled ii%fwork
/has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENEBAL CONTRA OR (or new G as applicable)
PRINT NAME ��¢.iZ�(% PRINT NAME. L(" �'
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
18 day of OCT 20 t7 by SHARON BATE
is personally known to me
nh; roduced F � as ID.
/ 017
Signa ure Notary Date
Revi ferl"04 /15�
"JANCY IWMS ARhAS ,;?- t",' l
My COMMISSION, 1i cF ;
EXPIRES Februa, I0 :x
I RoridallowvS,
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
1s day of OCT n �20 17 by
J 1 Y dho is personally known to
norwh pro as ID.
/ 017
Signatu e o Notary to
ytRr :Le NANCY MIMS ARMS TRONG
i M)' COMMISSION # FF197899
an EXPIRES February 10, 2019 LI (407); 39E 3
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