HomeMy WebLinkAboutCHANGE OF CONTRACTORSCANNED �
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,I). Ludecouw
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to.bc 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 S2,500 ($7,500 if A/C Change -out).: A recorded copy must be submitted prior to _
commencing any work. There is a $50.00 fee for the Change of Contractor.
x 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 S50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMT —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.
Date: 01*i2019
Permit Numbem -y r
Site Address:. o1'[-ICZb I�t,
Meeks State License OFC057372 SLC License
Original GC, subcontractor or owner/builder
Ridgeway Plumbing / Gregory Kozan State License CFC057754 SLC License
New GC, subcontractor
Reason for Cancellation Meeks Is off the Job
The undersigned does hereby agree to indemnify and hold harmless St Lucie County; its officers, agents and employees Eton
costs, fees or ages arising from any and all claims of action for any reason, whiff: a result of this change of
contractor" tit)tractor or cancellation of permit. A permit cannot be cancel f`w s beed perrormed,
SIGNATURE OF OWNER (or owner/builder) SIONA`fURE GI N CTOR for new GC. as applimble)
PRINT NA,t� Brian W Davidson PRINT NAME, regary Kozan
State of Ronda, County of St Lucre County State of Flonda, County of St Lucie County
The following instrument wnt acknowledged before me this
04 day, of January 20 t2 , by
;",
ally known who is personally known to me
'has produc as ID
_0110412019
datum of Nearyi Date
P,QVi3ed 04/I5/16
The following instrument was acknowledged before me this
,, day or !u.r 20 . by
personally known who is personally known to
me qr who has produced as ID
W2019
53.nat re or'Yotary Date
•., enact a.�'s3 ;
W. CCIM
9ur,'ed tnraoYn tiau . ;