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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 ......
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