HomeMy WebLinkAboutCHANGE OF CONTRACTORSCANNED
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 S E P 06 L 3 18
(772) 462-1553 FAX 462-1578 ST. Lucie County, Permittin
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
comlmenci ork. There is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
fi new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
C ntractor.
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: 4� 1rO 1 �<,
Permit Number:
Site Address: 1t0l 07 0'�1 q M nal Road,
State License SLC License
Original GC, subcontractor or owner/builder /' p
Jam Ql T n Q rd State License [[�� 4S7 OA SLC License a 5 ,�) /
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees mages 'sing from any and all claims of action for any reason, which may arise as a result of this chan
contra r contr or or a ' n of permit. A permit cannot be cancelled if wor s been performe
SI ATURE OWNER (or owner/builder) S ERAL CONTRACT (or new GC, as applicable)
PRINT AME is
INTNAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
d1y of 20C-, by
YRD IJ who i ersonally known to me
a who 1 s pn uced as 1.
R
Sig t re of Notary Date
Revised 04/15/16•v yra�e., ANGEELABORSODI-BIRMINGHAM
Notary Public - State of Florida
Commission GG 2a9625
My Comm. Expires Aug 16. 2022
Banded through National Notary Assr..
State of Florida, County of St. Lucie County
h llowin i stcu ent was ac o led ed before me this
g g
of ,�20 by
111Xs.1 tar who ' personally known to
or wh has oduced as ^Ap
Sign t eofNotary Dat
ANGELA BORSODI-BIRMINGHAM
:'a���G•
Notary Public - State of Florida
Commission X GG 249625
'? or My Comm. Expires Aug 16, 2022
Borded through National Notary Assn.