HomeMy WebLinkAboutCHANGE OF CONTRACTORCANNED
BY
SERVICES
BUILDING I & ZONING DIVISION
2300 VIRG
FORT PIE]
(772) 462-1.'
PLEASE SELECT ONE OF THE FOLLOWING:
X CHANGE OF CONTRACTOR — Chan
and the new contractor of record for the current pi
contractor information and signature. A new Noti
for job values greater than $2,500 ($7,500 if .
commencing any work. There is a $50.00 fee for
AVE
FL 34982
FAX 462-1578
FEB 0 2 2018
S LWsin @11f1CY� Per tdng
of Contractor is to be signed and notarized by the property owner,
lit. A new permit application must also be completed with new
of Commencement must be filed in the new contractor's name
Change -out). A recorded copy must be submitted prior to
e Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be signed by the general contractor only.
The new subcontractor must fill out a Subcontractor Agreement Form which is signed by both the contractor and
subcontractor. 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: �/ OZ-C�l Permit Number: lab
Site Address: U I�(�l,�lL-S y �iyT�Q -3 423 a
State License SLC License
dAffinal GC, subcontractor or owner/builder
LA _ State License SLC License
New GC, subcontractor or owner/builder
Reason for Cancellation
The undersigned does hereby agree to indemnify and
costs, fef4of damages arising from any and all claims
co Vac or c Ilatio . of permit. A
SIGN TUBE OF OWNER (or own / uilder)
PRINT NAME 4
State of Florida, County of St. Lucie County
The following ins ent was acknowledged before me this
—day of 20�� , by i rn
L Q,. �� O in -Y who is personally known to me
r who has producedas ID.
'ar.DEANNA MARIE I IVENS
MY COMMISSION # GG 022023
EXPIRES: December 16, 2020
0� 6" Notary Public Underwriters
Id harmless St Lucie County, its officers, agents and employees from all
action for any reason, which may arise as a result of this change of
•mit cannot be cancelled if work has been performed.
SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of . 20_, by
is personally known to
me or who has produced as ID.
Signature of Notary Date