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Home My WebLink AboutCHANGE OF SUB-CONTRACTORI �PLANNING & DUI BUILDING & ZOr 2300 VIRGINIA A BY St Lucie Caboty FORT PIERCE, (772) 462-1553 PLEASE SELECT ONE OF THE FOLLOWING: CHANGE OF CONTRACTOR — Change of Contra( and the new contractor of record for the current permit. A new contractor information and signature. A new Notice of Comm for job values greater than $2,500 ($7,500 if A/C Change commencing any work. There is a $50.00 fee for the Change CHANGE OF SUBCONTRACTOR — Subcontractor The new subcontractor must fill out a Subcontractor Asreemer Contractor. ELOPMLi,4 SERVICES [NG DIVISION _.._._ E RECEIVED 34982 'AN 2 8 2019 AX 462-1578 . ST. Lucie County, Permitting :or is to be signed and notarized by the property owner, permit application must also be completed with new =ement must be filed in the new contractor's name gut). A recorded copy must be submitted prior to )f Contractor. hanges are to be completed by the general contractor. Form. There is a $50.00 fee for the Change of Sub - CANCELLATION OF PERMIT — The cancellation ofla 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. I Date: Site Address: '7kq3 2 ( i :�A N ►P� �. IP�� Y I C. -t �1 r State Original GC, subcontractor or owner/builder 'Pv2 o ak- State New GC, s contractor Number: 'SZ—t /Pi 5- ,� 3 50 License V 413 2"WC License O� ( D Reason for Cancellation I The undersigned does hereby agree to indemnify and hold harmless St Lueie County, its officers, agents and employees from all costs, fe qsr damages arising from any and all claims of action for any reason, which may arise as a result of this change of contrac*/§ttbcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed. I rB OF OWNER (or �owner/builder) NAME State of Florida, County of St. Lucie County The following instrument was acknowledged before a this _day of_ Q 20 iR, by—J[�CL.L I who is personally known to me or whdNhs produced -W L VL— as ID. . Ia Date Revised 04/1 l.PpvP�e�;s •. - HOLLYS A. FILOMENA Notary Public - State 01 1`10110„ Commission # FF 986680 ♦ e My Comm. Expires Ap r 27, 2020 SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable) PRINT NAME I State of Florida County of St. Lucie County The following instrument was acknowledged before me this day of i , 20_, by who is personally known to me or who has produced as 1D. Signature of Notary Date PERMIT # PLANNING & DEVELO Building & Code Co BUILDING V SUB -CONTRACTOR SCANNED By 38t Lucie County 9/u e PAn ��Cr A)C- /Tu A K (0 P-6— I (Itompany Name/Individual T46ej the M E Gk h n1 tcAl 14 VA-C_ Sub -contract (Type of Trade) T ISSUE DATE I ' �- /: ' ;v/ v LENT SERVICES fliance Division =jRECEIVEDZITREEMENT A.. -)A. have agreed to be for (Primary Contractor) For the project located at 32 t. -5Ad 4JlebL ?—oo?_ P 2 C51 ( 3 9 �J (Project Street Address or Property Tax ID #) It is understood that, if there is any change of status regarding our participation with the above mentioned project, the BuildiW and Code Regulation Division of St. filing oJP;Chang6j6f Sub -contractor notice. /c/k./�1'zir A'11' SIGNATURE (Qualifier) PRINT'NAME " ' D �.S ►�� P ►emu i I � COUNTY CERTIFIC TIOC�'� BER v� State of Florida, County of � C' County will be advised pursuant to the SUBCONTRACTOR SIGNATURE (Qualtfer) NAME State oI Florida, County of The foregoing instrument was signed before me this ;S day of The fo legoing instrument was signed before me this o�5- d y of An, by - 1-0, %u 1 1 �C�� O e� v.�i{ , 20 , by who is personally known or has produced 01. FLI \ 1 3 C)Lf3 S S6 Sjkgo who is plersona y own 'or has produced a i as identification. as identification. STAMP ,,otPavPLa�4a PAULETTEBLAIJe a e Public - Signatu y P a ure of Notary Public • ¢ — 'c Commission 43 IMyComm.Ex Tr Print Name of Notad Public Print Name of Notary Public o�Pav °�a", HOLLYS A. FILOMENA 11 _: :° = Notary Public - State of Florida iNA Commission # FF 986680 • • OQ I Revised 11/16/2016 F� My Comm. Expires Apr 27, 2020 PI.tNC & I 2300 VIRGE41A FORT PIERCE,. (772) 462-1553 )PM9NT SERVICES DIVISION 34952 462-1575 PLEASE SELECT ONE OF THE FULL.OWING:. CHANGE OF CONTRACTOR- Change of Contractor is to. be signed and notarize d by the,properry 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 S2,500 ($7;500 if A/C Change -out). A recorded copy mustbe submitted. prior to commencing any. work. Where is a. S50.00 fee for The Change bf "Contractor.. _CHANGE OF SUJDCONTRACTOR Subcontractor changes are -to be completed by the general contractor.. The new subcontractor must fill out a Subcontractor Agreement Form. ')there is a S59.00 fee for the Chabge of Silb- Contractor. CANCELLATION OF PERMT - The cancel! Cancellation of permit is. to be.signed and notarized by cancellation of the permit. Site A d d ress: 1 /31:S-3 a Oragloal Reason for Cancellation rideq'iened d es hereby agee'to indemnify, and hold harm fees or d arising -from any and'all claims of action, ;trot/subco f or cancellation of permit. A<permit 6 State of Florido, iCouniy of St Lucie County^ 'the following instri cnt vkdacknowledged hcfooeF-c thi to me Revised VV 04/15/16" A VILUN1ENn Notary Publ!c State of Flu( !. 1 �N Commission # FF 986680 My Comm..Expires Apr 27, 2020 �I111111N11` of a permit is acceptable only if'no worlr has been.done. the owner and qualifier of record. Where is ho fees ffor Permits umber. SCC 1.965-63sty License k License 6C i U3 93.SsLC License St Lucie County, its officers, agents and employees.fron any reason, Which, may arise as aresulf of this change of it tie cancelled if effort; has been performed. rid at County of St. Lucie Courny ing instmmtht Sias acknowledged before me this of . 20 : by dfio is personally known to has produced as1b. of Notary Date N r' , rJ PERMIT # Lc i.qC6_-'03SD PLANNING & DEVE: Building & Code BUILDING (Company Name/(ndjvidual Name)' I the C= i0 r.4_d_c r 6� Sub (Type of Trade). For,the project located at —7 c93 - 2;ad (Project'street Address or It is understood -that, ifthere is any change of status ISSUE DATE" [LENT SERVICES Hance Division AGREEMENT have agreed.to be or for X {Primary Contractor) oy- b-r Tax ID #) ng our participation,With the above mentioned project, the Building and Code Regulation Division of SL Lucie County will be advised.pursuant.to the filing of a Cif #r&e of Sub -contractor notice. PRINT COUNTY CERTIFICATION NUR IIER Stnte of Florida, County of -54 e- The roregoins insim Z nt waa signed beforr 16iw�,y of hu� Wood who is personally known or has produced a L F L as idenlificatiom HOLLYS A. FILOMENA • Nolary Public - slate of Florida Signal t , . .oY; ommission IMP986680 . _ .. , FOFF�o •� My Comm. Expires Apr127, 2020 ,Revised 11/162016 � r 91k3 SU OKTRACTOR SIGNATURF. (Qualifier) PRINT NASIE COUNTY CERTIFICATION NUSIBER State of Florida, County of The foregoing instrument -vas signed before me lbij:z,:L day of who'is psryonLY t, wa_or has produce a= as Identification. Print Name of Notary Public STA1fP f, SWNl,9EQAANt ALONSO s Coaantsslnnl3@t3S�19b0 A= Exgkeslllnzl23,�A2Z ?gr�dp �+glood>,d�tQ�srya