HomeMy WebLinkAboutCHANGE OF CONTRACTOR§Grf3NNED i J
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PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECETVL-D
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 J U N 2 4 2019
(772) 462-1553 FAX 462-1578
ST. Lucie County, Permitting
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 Charige-out). A recorded copy must be submitted prior to
co en ' g 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:
Site Address: / 3
Permit Number:- V J,, =
State License SLC License
Origin C, subcontractor or owner/builder y
i .� ,/3"�0 1�,'i/
Q �' r 1 State License g cense
New GC, subcon actor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold hz
costs, fees or damages arising from any and all claims of acti
contractor/subcontractor or cancellation of permit. A permit
SIGNATURE OF OWNER (or owner/builder)
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
Revised 04/15/16
St Lucie County, its officers, agents and employees from all
any reaso which may arise as a result of this change of
�t be c lled if work has been performed.
GENERAL CONTRACTOR (or
new GC, asapplicable)
E 'e �G.-Zi i �('� V rYJ�i (-'J
State of Florida, County of St. Lucie County
ollowing ' from was ackn led be{o- m this
owing as
PST t'1
i
who is personally known to
me c hasupduced!L2_L__as ID��
store of Notary Date
�I JC1
EN
EMILIO GIL
Notary Public - State of Florida
Commission M GG 211245
My Comm. Expires Apr 25, 2022