HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CI•IANGE OF QUIUACTOR.'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: 5/1/2018
Site Address• 3010 NW RADLCIFFE WAY PALM CITY, FL 34990
Permit Number: 1712-0309
Climatrol Quality Aluminum State License SLC License sce131150789
Original 'GC, subcontractor or owner/builder
Universal World Construction State
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify mid hold harmless
costs, fees or damages arising from any and all claims of action for
contractor/subco ctor or cancellation ofpermit. A permit can
SIGMA, , R OWNER(or owner/builder) SICi
PRINT NSME Scott Harala
State of Florida, County of St. Lucie County
The fopowing ins
t
r
ument was acknowledged pcfore m1 a this 1,
dayof ?A l by vlc f� lr,�
i who is personally known to me
or who has c as ID.
Signature of N ry Date
..........
Pij.
Revised 04/15/16 z; 81VAN SM-4C!'lAR
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" 7fffio F-XPIRES April 10, 2021
License 30037
Cy, its otii . rsJ agents and employees frog
ich may.aps9las a result of this change of
if work h been Performed.
MAL CONTRACTOR (ornewGC.as applicable)
Vicente'Delgado
Bata ofTlodda, County of St. Lucie County
The following instrument was acknowledged before me this
tt dayof !L3 20 1B. by
Vice.nt Delga d whor{per; !'71ykntorm to ^I +•' }r^i�i�t i. it,,
aced tn,
°1 �'�i��s• Ilfd1f, I`tli)i:0 • ��-.0 ti�l ,°Shltt ��;
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