HomeMy WebLinkAboutCHANGE OF CONTRACTOR_ I SCANNED
St �ucle County
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for thel current permit. A new permit application must also be completed with new
contractor information and signature. new Notice of Commencement must be filed in the new contractor's name
for job v hies greater than $2 SOQ ($7;500if A/C Change=out} A:4ppot4ed. copy must be submitted prior to
coin; e'►ng any yvorlc. There:is. a 95U fJO,fce; fox trie Change.oi Contractor:,
C3 t1NGE;0 'SUBCONTRACT( — Subcontt etot clgartges: rt; to Ge:.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.
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Date:. I 1 .- Permit Number: � 5 ",. 05 +5
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Site Address: l5 _ 3 _�!(�'r-
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C State License SLC License. Z S �010 3
F—1 e- (` InI_ State License ECC)Cp-29 3 LC License
New G subcontractor
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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 damages arising from any and all claims of action for any reason, whio may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled i work has been performed.
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SIGNATURE OF OWNER (or owner/builder) SIGNATURE C TRACTOR (or new GC, as applicable)
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PRINT NAME., PRINT NAME:_ I P I Q tI�ej
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State of Florida, County of St. Lucie County State of Florida, County o t,.Lucie County
'Be following instrument was acknowledged before me this The following insttu njwas acknowledged before tpe this
day of 20_, by I day of 20-M, by W % I / CLW
who is personally known to me who is ovally kn wn to
or who has produced as ID, me or who roduced as ID.
Signature of Notary Date ignatu of Notary ate
Rebe�� puma
Revised 04/15/16 .�`�'�.'¢���; Issio�#GG06�76
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