HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 SCAN S
(772) 462-1553 FAX 462-1578 BY
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
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.
I 0 ^ l% Permit Number: / Ya 7— 0/(? 0
I� �o Sh u� / J"� ��� _State License SLC License c:�? L� J
Original GC, 1subcontractor or owner/builder
�h 0 lei 1� y j—} tt+- I e r 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/subcontractor or cancellation of permit. A permit cannot be ncefled if work been performed.
I6N" � a OFO J sr(oriow//neijj--u--il'Ic e'CJj A RE0G NE=CONTRA OR (or new GC, as applicable)
PRINT NAME D c%r' �(/ PO/� PRINT NAME ' C.V\0 ` l,A-S 1 ?• *�%OOJLPS
State of Florida, County of St. Lucie County
The following i ent was acknowledged
dbbefore
1me this
day of 20A by � 4V (
° who is persona known to e
or who as produced as
Signature of Notary U Date
Revised.04/15/16
AUDREY B. HUMPHREY
V° = MY COMMISSION U FF 174772
EXPIRES: March 6, 2019
Boeded Thni Notary Public Undewdters
State of Florida, County of St. Lucie County
The following lastrument was acknowledged before me this
&1 Si -day of * 20-12 by
who i ersorially Ino to
me-ormho has produced as ID.
Signature of Notary Date
REBECCAWOODS
* * Commission # GG 130307
Expires August 14, 2021
FOFPti°� BondedTh kdg*NotWSwjb"
I 180 7 (0)L
PERMIT #
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
Name)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Sub -contractor for
have agreed to be
t(ypedTrade) (Primary Contractor)
or the project located at c ACA � Lnc7�e: - �� �� � ��-- �
(Project Street add ess o Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
C. V iC'Ae-S
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of % e
The foregoing instrument was signed before me this o` +day of
20by
who is personally known Xor has produced a
Revised 11/16/2016
SUBT Nj l (}1 1$%_ ATUREj{Qualifier)
T��.� l c N\ Mans A, Her
PRINT NAME
6 7
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this a2day of
by
who is personally known '�-or has produced a
as identification.
STAMP 1H10 STAMP
Signature of N-olary Public
Print Name of Notary Public
ro1a�;!?�ero RESECCAWOODS
* * Cornmmission # G0_130307
N. a Expires August 14, 202b.
Banded Thruaudg#lNougBery 9l_
OIANA L:, MATTHEWS
Notary Public - State of Florida
ta
' My Comm.!Expires Sep Ii. 2018
.�d; Commission # FF 135483