HomeMy WebLinkAboutCHANGE OF CONTRACTORi
PLANNING & DEVELOPMENT SERVICES <�
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE, FL 34982 APR 0 4 2018
(772) 462-1553 FAX 462-1578
ST, L,ucio County, Permitting
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 PERNITT — 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 / Permit Number:
Site Address: 36 6 D S' �,. �tr. pr?, 3 q
6r, c e.. 'ec kState License SLC License
Original GC, subcontrac1too or own
er/builder
/Vos rep, / V/i, I State License SLC 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 claims of action for any reason, which may arise as a result of this change of
contr ctor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURKOF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME N ��•%" W11� PRINTNAME
State of FloridjR
ounty of St. Lucie County State of Florida, County of St. Lucie County
Th following nt was ackn�edged befo s W C ` The following instrument was acknowledged before me this
day of 20 by r I day of . 20_, by
G l, b who is personally known to me who is personally known to
or who b produ D as ID. me or who has produced as 11).
Signature of Notary Date gnature of Notary
KAREN S. NIELSEN
Commission # FF 115637
Revised 04/15/16 =°`= My Commission Expires
June 12, 2018
Date