HomeMy WebLinkAboutCHANGE OF CONTRACTOR 6-20-19PLANNING & DEVELOPMENT SERVICES
V.rr mso
11111311 DING & ZONING DIVISION "el
GINIA AVE, 0
ERCE, FL 34982 Dep
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1553 FAX 462-1578 St. V�dle
2300 N
FORT
(772)4
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR - C
and the new contractor of record for the cuffer
tdhttattdk infidtdidti6ti and sigtidtukd. A rieW I
for job values greater than $2,500 ($7,500
comm
,�,ncing any work. There is a $50.00 fee
V C-HANGE 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
)tid� -of Cbmm�ficem�fit rhii§t bd filed ih thd iid* cdhtidbtdk'� hEiffi6
� A/C Change -out). A recorded copy must be submitted prior to
or the Change of Contractor.
dfe- io- b6 66111016ied by ifi6 joher--a-1 c16fit�66t&
ctor Agreement Form. There is a $50.00 fee for the Change of Sub -
CANCELLATION OF PERMIT - TH6 cani:Wlatibri of a permit is acc�ptdbI6 bnl� if hd *dfk hd§ b66h ddii6.
Cancellation of permit is to be signed and notalrized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date:
Site Address:
_eDV,4P_1)V 6AR)IMA '
Original GC, subcontractor or owner/builder
I 'TJ' MOYW'Z-
New (50-, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify a
c6§t§, fet� or ddrxidge§ arising from dny Ariddll cla
contractorlsubcontractor or cancellation of permit.
SIGNATURE OF OWNER (or owneribuilder)
PRINT NAME
96ie &f Flbrida, C6iini� of St. Lu6i� Cburity
The fol lo-,%ring instrument was acknowledged before me this
—_--day of 20_, by —
who is personally known to the
or who has produceo__as ID.
Signature of Notary Date
Revised 04/15/16
Permit Number: — Mol — 0511 -
LicenseCF�_ )q 281 LC License 3114 0
State LicenseCFf, 14 Z9456 SLC License �'? (0
-hold -harmless S Lucie County, its officers, agents and employees from all
� of action for any reason, which may arise ii8 a regult of this change of
permit cannot be cancelled if work has J),pen performed.
SIGNATURE GENERAL CONT CTOR (or new GC, as applicable)
PRINT NAME =DO 9V 1,600
Sffiie bf Fldrid�, County of St. Lii6ie County
The following instrument was acknowledged before me this
_SDday of T,%
Z) 20WJ���_('Ol_eoo
who is personally knoft to
me or who has produced —FL J>�as ED.
Signature of
E __TN VA U G H 1`77'
L L E --
State of Florida-N6tary F.
Commission # GG 27C
My Commission E pi
October 22 20X
---- z---- 22
i
PLANNING & DEVELOPMENT SERVICES
BUILDE�G & ZONING DIVISION
2300 VIRGINIA AVE
i
FORT FiERCE, FL 34982
(772) 462! L1553 FAX 462-1578
CTO
.PLEASE SELECT ONE OF THE FOLLOWING:
A/ CHANGE OF CONTRACTOR — Ch
and the new contractor of record for the current
contractor information and signature. A new N
for job values greater than $2,500 ($7,500 i
commencing any work. There is a $50.00 fee f
Imp,
ge of Contractor is to be signed and notarized by the property owner,
armit. A new permit application must also be completed with new
ice of Commencement must be filed in the new contractor's name
A/C Change -out). A recorded copy must be submitted prior to
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 —
Cancellation of permit is to be signed and i
cancellation of the permit.
Date:
Site Address:
0 DAI, DD I
4ql(o �,)
cancellation of a permit is acceptable only if no work has been done.
zed by both the owner and qualifier of record. There is no fee for
H
Permit Number: / q () I - 05 */
License -WC 04+9,89 SLC License 3 0 '740
Original GC, subcontractor or owner/builder
UmAqDO )2� -MLC-0 0 State LicenseCfiC 1594L(4,5SLCLicense z)1143
New GC, subcontractoii
Reason for Cancellation I
I
The undersigned does hereby agree to indemnify a
costs, fees or damages arising ftom any and all cla
contracto ttbeontrCctor or cancellation of permit.
SIGNATURE WOWNER (or owner/builder)
PRINT NAME C)
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this I
I/ —day of At/ 20it by ful 4-- 1
who i ersonally known to me
or�� �-ed as
,g
S1191, ture Cf Notary Date
hold harmless St Lucie County, its officers, agents and employees from all
; of action for any reason, which may arise as a result of this change of
permit cannot be cancell d if work een performed.
SIGNATURE GENERAL C TRACTOR (or new GC, as applicable)
PRINTNAME P412 DV �TVLZDC)
Revised 04/15/16
KATHERINE PEDROZA
Y COMMISSION # FF 977632
EXPIRES: Ju'� 31, 2020
Thu Notary pubVC Undmvi
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_2 _Oday of 1, 00 20A.�(by .577( DL,/
e Pz Ily known to.
me or who has produced7ELOL— as ID.
Signature of Notary Date
,\%% I I I I//,,
ELLEN VAU
i:� state 0 Florida. o
*C tary Public
7,,.,- Commission # GG 270079
n im My CO (sSion Expires
00t0ber 22, 2092