HomeMy WebLinkAboutCHANGE OF OF SUB-CONTRACTOR 9-12-1809/10/2018 08:56 AM PDT TO:17724621578 FROM:5616880909 Page: 1
soAMED
BY -
&05111 a ,h`x {s, PLANNING` EVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE FRECEIVED
FORT PIERCE, FL 34982 �(772) 462-1553 FAX 462-1578
nty, Permitting
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
con encing 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: C .Permit Number:
Site -Address: (9
y' Y-e SS State License N16 /25�05LkC License
Original GC,fiubcontra or or owner/builder
—}— i State LicenseC,4G %Pi I �IS�,�SLC License
Neti�Gcontractorj
Reason for Cancellation Ytal_�) 00") 0/1C1 �� , vIf"-P_J
The undersigned does hereby agree to indemnify and hold harmless St Lucie Coun , its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, wlih may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_, by
who N personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
rOR (or new GC, as
I
State of Florida, County cif St. Lucie County
The following instmjtunt was acknowledged before me this
ay of
20Z by l / l G' i77
N ! Id/0✓ what personally own to
ma".9 who ras product{. ---was ID.
/,P
ignat re of No a Date
Rebecca"Uinta K
fvY; COMM GGU608-1u
rr �� ��'� xpires: January 9, 2421
thru Aaron 140tarl
09/10/2018 08:56 AM PDT T0:17724621578 FROM:5616880909 Page:
[PERMIT# LTV of I 155UE PATE
v t�J / �
Z_�a_m) I L'i X��
(Companoainc.�Fnd
the y�l Ca
(Type of Trade)
For the project located at
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
G
2
RECEIVED
SEP 122018
ST. Lucie County, Permitting
have agreed to be
Sub -contractor for
(PrimaryConlraetor),,
Z��d (1��
(Project Strect Address or Property Tax TD f+:)
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.
f2. e6C oC//YS
Sfatc of Florida, county orb "e—
The foregoing instrument was signed bcrarc me Ibis '7 day or
Gt r1 Q 2a l by /� �� l G YrLt IZ�
who is Personoily known �r lias produced a
��; :Pu��f� y CoM011"' , 9, gut
-�= lEons. � � alo��ataN
/r,�a� gOn�9� it1
Iteoiwd 11+16i2016
GGt�C-c. c.t,•L.
SU-CONTRACTOR SIGNA RE (Qunlif=er)
PRINT NAMIR & -110.qC l8I V'r') S'
COUNTY CERTTFICATION NUMBER
State of Florida, County of s to Qt�t1L
The foregoing instrument was signed before me this da; of
+ho is personullp known /or has produced u ` _
as Identirication.
P /', -Z L--), iTAMP
Signature orNolarr Public
Priat Name of Notary Public --
VICTORIA L CLOS
My COMMISSION 6 GG070545
"• EJ kES J ebtuety 07, 2021