HomeMy WebLinkAboutCHANGE OF CONTRACTOR 10-18-19-ir I
SGANNc�u
WY
PLANAING*fifft"COPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
1� 61 1 , en�L
(772) 462-1553 FAX 462-1578
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PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — C
and the new contractor of record for the currer
contractor information and signature. A new I
for job values greater than $2,500 ($7,500
co ncmg any work. There is a $50.00 fee
7 CHANGE OF SUBCONTRACTOR
The new subcontractor must fill out a Subcont
Contractor.
inge of Contractor is to be signed and notarized by the property owner,
permit. A new permit application must also be completed with new
)tice of Commencement must be filed in the new contractor's name
7 A/C Change -out). A recorded copy must be submitted prior to
)r the Change of Contractor.
Subcontractor changes are to be completed by the general contractor.
ctor Agreement Form. There is a $50.00 fee for the Change of Sub -
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date:
Site Address: A)
eulrt&l
11
Original Ge, subcontract(Tr or owner/builder
A,&,gm, Aa�p% 4w ot
1�e;v GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and I
costs, fees or damages arising from any and all claims
contractor/subcontractor or cancellation of permit. A I
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
____Aay of 20_ by -
PermitNumber: lfo/_0153�1
License SLC License
License 0/77-09LC License
d harmless St Lucie County, its officers, agents and employees from all
action for any reason, which may arise as a result of this change of
mit cannot be cancelled if work ha&been nerformed.
SIGNATURE GENERAL CO (or new GC, as applicable)
PRINTNAME
State of Florida, County of St. Lucie County
The followig instruin t
C p., acl!ogledged before me this
_(_�Pay of (Z) A by
who is personally known to me who is pe Qy known to
or who has produced as 11). me orwho has produced
IeI6
Signature of Notary Date Signature ol4l;i;?�y' D Co da-P
I Sir � tary p Ubj
C # G 270
'Ssior7 3,�;
_079
Revised 04/15/16 '1, 2 F, us
the
PLANNING DEVELOPMENT' SERVICES
Building! & Code Compliance Division
,91JILD-ING PERMIT
)NTRACTO - R AGREEMENT
/��4 eAll ,>It 11 6004_�
(Type
For the project located at
It is understood that� ifthore is'any change of.
project, the Building, and Code. Regulation
filing of a- Change of Sub, -contractor notice.
5U It �>
State of Flori.dai CounItyof __ DA�Dgo
The, foregoing. instrument was signed before me this IK'dayof
have. agreed -to be
8ub-qqntractorhr AOTAAZ COVSM6"Ok)
-(Pritnary Contractor)
I'
49_d+!6e-V-.201$ by 17�-01
who Is personally -know. C//Or has�produced�a
as identification.
0 STAMP
'91� uxe of Noiary.'Public
gnat
\A " \ Xcl<
print Nanieof Notary Public
MARIA DIAZ
Notary Public - Stali of Florli
commission #10 055017
Revised 11/16/2016 My Comm. Expires Dec 13,20
Bonded through National Notary As
Tax ID'
regarding, our participation withlfieabove� mentioned,
of St Lucie County w ill beadviged pursuant to the
4gu 137-C ONTRk' CTO�, �! Q�ATVRI�,(Quallfle r)
PRINT NAME
6d 6- 49 el
COUNTY CERTIFICATION'NUMBER
State of Florida, County of —
The foregoing instrument was �signed before.me this 90,dayof
26 d' by
w . ho'is personally- known —or,has. produced a
as , Identification.
MARIELYS GARCIA
Notary Public - State of Florida
COmISTAMG 149939
signature ofNota' Public
My Comm. Expires Dec 7,2021
1
Manded through National Notary Assn.