HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SER
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
RECEIVED
OCT 2 6 201$
ST. Lude County,
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.
I-NVU 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:
10/26/2018 Permit Number: 1712-0312
Site Address: 3034 NW Radcliffe Way
�I RAState License (c(e; License
Original GC, subcontractor or owner/builder
Universal World Construction
New GC, subcontractor
Reason for Cancellation
License CGC-1506324 SLC License
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 r son, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit ca \Ikbcan ork.has been performed.
SI ATURE OF OWNER (or owner/builder) SIGNAYUKEGENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME <� 0-�k L-�r(-CLLck PRINT NAME Vicente Delgado
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
26 day of Oct- �, 20- by
%LoR 1 c' rCca Gt_ who is personally known to me
has produced as ID.
10/26/2018
Date
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The following instrument was acknowledged before me this
26 day of De7!!!�� , 20 18 , by Vicente Delgado
Signature of Notary
is personally known to
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