HomeMy WebLinkAboutCHANGE OF CONTRACTORP� 11NNG & DEVELOPMENT SERVICES R
� T&W� G ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLEASAELECT ONE OF THE FOLLOWING:
i
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 alues greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
comm cing 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.
II
Date: �l 5A Imo. Permit Number:
Site Address.'/ s• 2 SB' dart r Kl" -e A/v
13
ItM��� Ar1'�_ State License SLC License
l!J
Original GC, subcontractor or owner/builder
State License SLC License
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 damages arising from any. and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontr for or c�permit. A permit cannot be cancelled if work has been performed.
LOSIGNNTURE'OFO (or owner/builder)y SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
V
PRINT NAME e�� Le d / !?i�'� 1 PRINTNAME-
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged befor me this The following instrument was acknowledged before me this
day of �" �%� . 20 by—� L—LA u9� Vk O day of 20_ by
who is personally known to me who is personally known to
or who has pr%Luped 1^ L as ID. me or who has produced - as ID.
Signa g ate Signature of Notary Date
ELLEN VAIJGHN
SM,UBr
;State of Florida -Notary Public
Revi dy a6Commission # GG 270079
My Commission Expires
Ottobet 22, 2o22
- I V - • M
1
I
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION p 'cF� N
230,0 VIRGINIA AVE s171hi,�9
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,
a..0 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 alues greater than $2;500 ($7,500 if A/C Change -out).. A recorded copy must be submitted prior to
comet cing 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 sand notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
bate: /)l Permit Number:
.13 2.5'K h � Lo4 rSite Address�
i
License SLC License
Original GC, subcontractor or owner/builder
License SLC License
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 damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontrWtor or_gance11ati'on of permit. A permit cannot be cancelled if wor"s jrn performed.
SIGNA O O (or owner/builder) $IAA 1'fJRb`-GEN&iL CONTRACTOR (or new GC, as applicable)
PRINT NAME J� Low•t NAME 4r Z. 4 "e y
State of Florida, County of St. Lucie County I State of Florida, County of St. Lucie County
The following instrument was ackn wledged befoi me this TWollowin ent was acknowledged be this
_. 2� by—1 I F —� u9b' k j day of 2
day of �"C/� Y ��i
who is personally (mown to me _ who is personally (mown to
or who has pro ed ram(. L as ID. me or who has produced (F as ID.
SiEna_2JDate I Signature otary Date
ELLEN VAUGHN , o�,,
�%
State of -Florida -Notary Public '� Siate LLEN VAUG
.6Commission # GG 210079 �114
of Florida_ HN
MY Commission Explres �''% ``` My �ossion # �� 270p� I
00to60r 22, 2092