HomeMy WebLinkAboutCHANCE OF CONTRACTOR4
CtqNTY
„F, t_ D A
PLANNING & DEVELOPMENT SER`'ICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE SCANNED
FORT PIERCE, FL 349821 BY
(772) 462-1553 FAX 462-1578 StLudeC0110 `,
PLEASE SELECT O`1: UF TIlit'I-ULLONVI`G:
t%CHA\GE OF co-,'1 k:�C''TOK — Chan of Contractor is to
and the new contractor of record for the current permit. A new permit
cotractor information and signature —A new `otice of Commeneemel
tier job values Lureater than S_.M (57,5O0 if' AC Chance -nut),
commencing any work. There is a S50.00 fee for the Change of Cont
is silmed and notarized b%!1the property owner.
)pplication must also be completed with nett
t must be tiled in the new contractor's, name
recorded copy must be submitted prior to
'actor.
CHANGE OF SUBCONTRACTOR —Subcontractor cltangesl are to be completed by the general contractor.
The new subcontractor must till out a Subcontractor Aureenteni Forth. There is a S50.00 fee for the Change of Sub -
Contractor.
CANCELL VI ION OF 11M.NII1'— The cancellation ofa permit is acceptable only if no work,has,been done.
Cancellation of permit is to be signed and notarized by both the ownt.r and qualifier of record..There is no fee for
cancellation of the permit.
Ditte: I,
Permit Number: -)I Q y- OR
R D
Site Address: otoC_ �yokao
VIA t Y ` —Mate Li
Ori-inal GC, - fhcontractor or owner builder
MQLU �_ State I.i
New, ILK% subcontractor
Kea;on for Cancellation
The undersigned does hereby aree to indemnify and hold harmleis St Lucie
cats. fee, or damttgt arising from any and all claims of action fur any reasc
contractor 'ubcantractZorancellation of permit. A pern)lt cannot be cant
tilt, M[l'Etl,ifl'U��`hR(onncnerbutlderl SIGN\IIll' G
oL%t 003 PItIN I `\\II:
State nt'l•tanda" t•ount;,or t. Lucie taunt} State ot'I- omb.
e, fi+lloa m_, lmuument µa; acknowtudged hdore in4 this, 1 he IbIlow mQ u
da} ul 24J.. h,—_—__,_,• da} of
a t t: perdonath Lntmn it, me
nr aha ha pr •c�t! as IU ma or w hn has, I
signature or Notar% Date Signalure or 1
t�
1
SI.0 License
Iuntr, its,6fticers. agenti and employees from all
uhich may itncc as a result of this chaiwe of
ed if work has been performed.
l-R \ I, t't )ti71i \t" I "t Nt a+r nLu (it:. as :tpphcahtct
untn ofst, LuemCount}
anent wa, aAnoutedged helbre me thus,
'1}_ b%
Kho t; pcnimalh hMtNn, to
lueci_ - -a, 11)
n Date
off."'
Notcry public S!atu of Florida
Sr,t;itra Leone
;o'
Commin_!oa GG 020251
Expro" CLIM +Z020