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HomeMy WebLinkAboutCHANGE OF SUB-CONTRACTORL_ PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION • 2300 VIRGINIA AVE RECEIVED ^ FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 J U N 0 5 2018 St Luce County ST. Lucie County, Permitting CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMIT 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 vela eater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted Prior to co . 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: "�J � Permit Numbe Site Address: �lg ©(L(�11 T1 m IQI F I State License SLC License Original GC, subcontractor or owner/builder / Ado State Licensedlooz %3 SLC License 3 �� I New GC, subcontractor �', 9�� 101 Reason for Cancellation hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all The undersigned -does costs, fees or damages arising from any and all claims of action for any reason, which may an- s change of contractor/subdon ctor or cancellation of permit. A permit cannot be cancell as bbeen pie pa• OFGENERAL CONTRACTOR (or new GC, as applicable) �GNATURB 'OnWNER (or owner/buiMlder) I I PRINT NAME V L'� CE1` 1 =�U14 A-0 PRn3TNAMB_. Q •� i c� C r P S io 1 State of Florida, County of SL Lucie County The following instrument was aclmowiedged before me this 5�dyof SUN E . 20_1a by M P-a ,�e l l I n D I \ k who is personally known to me t_br2iDA 85 L i cep. or p� 10�5 signatpre of Notary mte State ofEorida, County of SL Lucie County The following insmnmem was WAnawledged bef a me this it dayof Sk'�i .20 by Za--,`r� � `per_ wh (mown me or who has prodaccd ? i1f— as ID. signawe of Notary Date (,7 / ( /-2-0 \ Revised o4/15l1 ORLANDOVAZQUEZ K=maxh Notary Public -State of Florida d t,f Commission = GG 189841 �'qrw� My Comm. Expires Feb 26, 2022 " Bonded through National Notary Assn. the PERMIT # t �J 1 Ti H I ISSUE DATE of Trade) PLANNING & DEVELOPMENT SERVICES Building & Code Complianee Division Name) BUILDING PERMIT SUB -CONTRACTOR AGREEMENT RECEIVED JUN 0 5 2018 ST. Lucie County, Permitting have agreed to be Sub -contractor for 4A1alJ (Primary contractor) For the project located at /75 0 /0 (Project Street Addreas or Tax ID #) S .6410 It is understood that, if there is any change of status regarding our participation with the above mentioned project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub -contractor notice_ ONTRACTOR SIGNATURE (QuAGer) PRM NAME COUNTY CERTIFICATION PLUMBER State of Florlda, County of %'R Q The foregoing instrument was signed before we this l-kday of .2i1_§hy who is personally Irnown or has produced a as identification. STAMP Sig —tore Nd abllc print Name of Notary Public KELLY ? r P OD,NNO Revised 1I/161201Aoffftw,KELLY M. RODANO WCOMMISSION 4 i+F2WW FIRES: Mamh2T, 2019 s�' r J c-c>'2- ? COUNTY CERTIFICATION NUMB,ERr ' State of Florida, County of L ud—p— The fo Ing instrument was signed before me this -day of who Is personally Imown _or has produced a r c . D as identtflcatiou STAMP Sig of Notarypubflt Moan Print Name of Notary Public LAURAMANN Notary Public - State of Florida KIA' y o Commission H GG 196536 ''••.•?�oo?:= My Comm. Expires Apr 24, 2022 Ronded through National Notary Assn. ,.•a ...... sy47s4 sy47s4