HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2.3,00 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR. SUBCONTRACTOU OR CANCELLATION OF PER IT
PLFASE SELECT ONE OF THE VOLLOWING:
CHANGE OF CONTRACTOR— Change of Contractor is to be signed and notarized by the property owner, newt
the new contractor of record for the current permit. A new permit application must also be completed with ,
contractor inforniation, and signature. A new Notice of Commencement rh.ust be filed inthe new contractor's name,
for job values greater than S2,500 ($7,500 if A/C Change -out). A recorded copy must be subinifted prior to
commencing an wo& There is a $50.00 fee for the Change of Contractor.
M! Y
x CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor,
The new subcontractor must fill out a Subcontractor Agreement Form. Thiere is a $50.00 fee for the Change of Sub,
Contractor,
-1 11, 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. 1217/2017
Site Address.: 6401 S Indian River Drive, Fort Pierce, Fl. 34982
Permit Number: 1706-0436
Coastal Heating and Air Conditioning Mate CAC058137
License S'LC License
Originat GC, subcontractor or oxvner/builder
Dynamic Air Quality tateLicense i,-AC1818454 SLC License
New GC, subcontractor
Reason for Cancellation Coastal is unable to do the job.
The undersigned does hereby agree to indeninify and hold hardiless Si Lucie County, its offlcers, agents and employees. from all
costa, fees or damages arising,*om any and. all claims of action for arty reasmi, which may "e as a result of this change of
contractor/subcontractor or cancellatiun of permit. A perm camii ca C Il d if work has-been pet -formed.
SIGNATURF OF dwi tk -or owneribuilder) SIG f V G CON-MACTOR for new CC, as applicable)
PRZNT NAME PRINT, v . San George, Jr,
State of Florida. Counry oT & Lucic Caunty
The folloAlitig instrument ww ack'no8vledged before me this
20— by--
ultti is pel-sonally known to me
or who has produced —as FD,
IZ7,12017
Slignatum of Notory Date
Revised 04/15/.16
Sta.le of Florida,. Couray of St, Ltwic Co%anry
'cite following instrurnmt,was acknowledged denote 0 is
—a—dk, of_, 20-11 by:E)q,1Wi
who i,.; 11 orall y kn%,n tQ
Al
Inc o'bas roduced
1217
i re OrNo Rate
SR ANDYN meNAmARA
MY COMMISSION # GG032190
EXPfRESNover"t)er27.2o2o
i PERMIT #
ISSUE
PLANNLNG & DENTLOPMENT SERVIC S
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Buildinst, & Code CornpUnc
e Division �4
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I
OWN&
BUILDING IT PUN I I T 6
SUB -CONTRACTOR AGRI-'-KINIENT
T11 U la, , Q Liiz- have kgrecd to be
((-.tlmpiln%,,N'al'IC?'Iritlividtia) Nitric)
Sub -contractor lbr —a2L,-N v
kj�-ris: orr-,,tdc�) (Pritnary
-01. tilt: project located ,Jj /Ork) ro Te -trce , K� I Addxess or Proptriv Tax ID #)
It is understood that, if ' there is an changeofstaLms
y rcgarding our pafticipation with the above mell-Liolled
prkjec,,, the Building and Code Rqwlation Divi,.sipn of St- l.ucie CoLljity will he advis�d pursuant to tf)e
of a Chatxt: of Sub -con
(:4 rp,A.CT0K SI(
notice-
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SUN of Florida, C4iaqt_N• of 'n . -MaOn
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tmbex - zon, ,3,,jnd6 15
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PRINT NA%W
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stau.. of mqridr. county of
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Th,: fnr,:poj;,,., instmincol vpx5 5irted I,
who is per.sAMOV known /--1 luts produced a
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L KrAN
Pit ic �t
.r� Sig ruiv Ur No", "Public
a IN61.4ry Public
Prin' X311- QrNolnry -[,Wit
BRANDYN MCNAMARA
,U%
MY COMMISSIONAk GG032190
'-.',?a,
EXPIRES November 27,2020
Frill' Kamc o('%,'.*ury rubric
NC)TARY purUC
sTArE OF FLORIDA
ME-, V.--, t�i CC It* rF951 618
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