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 Corrnnencement must be filed in the new contractor's name
for job values greater than $2,500 ($7;5.00 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 PERAMT - 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: i 0I b N Permit Number: ! -70 - & 17
Site Address: �014 USQr.�, (.-,QJ, 3
--r au , — `Jr rtir t. - turn, - r — !(L - state License J_ ! I l b `IYn !SLC License
Original GC, subcontractor or owner/builder
Y�l J ' J (at �u State Licensee' 0 4 )_7SLC License
New GC, subcontractor
Reason for Cancellation
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 ims of action for any reason, which may arise as a result of this change of
con for/subcontractor or lation of p it.. A permit cannot be c nce11 d if w k as been performed.
SIGNATURE OF OWNER (or owner uil er) ST NATURE GE - T CONTRACTOR (ornew GC, as applicable)
PRINT NAME 'i� tA-h y1 ✓1 G (��S PRINTNAME NNl1� Gl.F1�
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowI dg efore me this _ Thf% followin in m t was ackn 1 g efore mp this
_0 day of 20 by Ah[ 4%" " day of V . 20. by /1 L' .
who is personallyknown to me n"� who is personally.known to
who has produce I I me or has produced a ID.
Signature of tary Date Signature f Npta Date
Revised 04/15/16 iVi6PlCir NiIiNS AfiMSiROidG
' MY COMMISSION # FF197899
''•� - °' EXPIRES February 10, 2019
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