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HomeMy WebLinkAboutCHANGE OF CONTRACTORQCANNE® - BY St Lucie County - PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE ®2019 FORT PIERCE, FL 34982 JUN 2 (772) 462-1553 FAX 462-1578 per Sti tL g po nmet 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' iiif iti iatiori and signature. A ii& Notice of Comm, e.ncement trust 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 comm,,pncing any work. There is a $50.00 fee for the Change of Contractor. CHANGE OF SUBCONTRACTOR - Subcontractor changes Ave- to be- co npl&fed F} the general 66nfrac"i6r. The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub - Contractor. CANCE 11, L,ATIONN OF PERMIT - The cancellation of a per ririt is adc`e'0 1ble' 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. Rate: D� � Site Address: yq*)v I!A Permit Number: I90l - 015J7ZVr1 DVA120D 3A 5m.)A State License Cf e 14 2 1 1SLC License Original GC, subcontractor or owner/builder YYu-y1 1 A 104J 0? State LicenseC;C I4A 1456 SLC License o261 (056 New , subcontractor Reason for Cancellation FAYZ E/2Zlo '-J-29-8 &/7-rF The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all costs, feeg of damages arising from any and all claims of diction for dny reason, which may arise ag a result of this change of contractor/subcontractor or cancellation of permit. A permit cannot be cancelledjj.Avory-h�s been performed. SIGNATURE OF OWNER (or owner/builder) PRINT NAME State of Florida; !county of St: hucie County The following instrument Nius acknowledged before me this day of 20_, by who is personally known to me or who has produced as m. Signature o `otati�,,, E t- N VA U G H N PUB! H�State of Florida -Notary Public =• Commission # GG 270079 Revised MY Commission Expires October 22, 2022 / S SIGNATURE GENERAL NTRACTOR (or new GC, as applicable) PRINT NAME 0 State of Florida; County of St. Lucie County The following instagnent was acknowledged efore me this Jday of , 204 by DJ IZRYM buz� who is personally known to me or who has producedEP L as ID. — Signature of Notary \,I_ Date Stat of F olrida N ' VA --G- C ommission # GG 270079 My Commission Expires October 22, 2022 PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 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 commencing 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: � o� 9TL 7 Permit Number: I Site Address: 4 *l D &-" Am State License 0 0f 0*7 LC License 3©9+77V Original GC, subcontractor or owner/builder �L� )WAIIAN D"D 2EO -ML60O State License64C /S2` 445SLC License 3 / 143 New GC, subcontractor Reason for Cancellation The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all costs, fees or amages arising from any and all claims of action for any reason, which may arise as a result of this change of contr ct'1`s ; cont ac , or cancellation of permit. A permit cannot be cancelled if work has b n performed. SIG OF OWNER (or owner/builder) SIGNATURE GENERAL CONT CTOR (or new GC, as applicable) PRINT NAME fM ��' ' t✓ PRINT NAIVE AeMM `VIeDD State of Florida, County of St. Lucie County ThTfollowing instrument was acknowledged day of 1J n 20A by who i persc or who has prod as m of N6tary Date State of Florida, County of St. Lucie County me this � + Qfl The following instrument was acknowledged before me this _9 Cay of �%a O 201�k by E0_7to me Qk—f `(1��who is personally known to A �( me or who has produced r-COLas ID. C V (-- Signature of Nota Date Revised 04/15/16 .+� P KATHERINEC.PEDR07A MY COMMISSION # FF 917632 j EXPIRES: July 31, 2020 Oonded Thor Notary Public Undeawdters