HomeMy WebLinkAboutCHANGE OF CONTRACTOR 4-18-19I
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PLANNING & DEVELOPMENT SERVICES
rv� r BUILDING & ZONING DIVISION RECEIVED
• 2300 VIRGINIA AVE
- F APR 19 2019
ORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 ST. Lucie county, Permitting
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the prope owner,
and they new contractor of record for the current permit. A new permit application must also be completed with new
contras or information and signature. A new Notice of Commencement must be filed in the new contractor's name
for jolI values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
COTTcing any work. There is a $50.00 fee for the Change of Contractor.
HANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The ne; subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
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II CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancel ation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancel on of the permit. C/ 2
Date: _ r/ ( Permit Number:
Ill d �uc�>o�e�� cma �� cal T �1•� C;��; ��
Site Address:
State License SLC License
Origin'd GC, subcontractor or Owner/builder
��.{� c►e �, State License &_ 3Do:57202 License
New 63, subcontractor
Reason or Cancellation 4 )iv �� V 0 t S
The undersigned does hereby agree d mni
and hold harmless St Lucie County, its officers, agents and employees froth
to inall
costs, f�i damages arising fr . an d all claims of action for any reason, which may arise as a result of this change of
contrao'�� b ntracto 11 on of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE GENERAL CONTRA% I OR (or new GC, as applicable)
SI A OFo rowln,,e'dbuilder)
PRINT AME O /�/ W 4 f /w -C - — PST NAME
State ofFlorida, County of St. Lucie County
state of lorida, County of St Lucie County
The following instrument was acknowledged before me this
The foil g instrument was acknowledged before me this
day of 20— byr--
�tY.
1�I y of f1f1i. 20J by�
known to
S! 0//',� me
'yF
who Is personally
as ID.
or 5 ID.
me or who has poured--
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goat+i of No a `Da�esb =
signature of Notary Date
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Revis 1 04/15/16
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