HomeMy WebLinkAboutCHANGE OD SUB-CONTRACTOR 4-30-19� Sot
LANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
Sly (772) 462-1553 FAX 462-1578
iLucie Counw
i CHANGE OF CONTRACTOR. STTRCONTRACTOR OR CANCELLATION OF PERMT
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by e property owner,
and t ie new contractor of record for the current permit. A new permit application must also be completed with new
conti ictor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for j b values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
comi. encing 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 fiew subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contactor.
9755EN ^ CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no Jork has been done.
Canc Alation of permit is to be signed and notarized by both the owner and qualifier of record. 'There is no fee for
cane llation of the permit.
I
04/30/2019 1808-0637
Date. Permit Number:
i
SiteAddress: 3755 Eleven Mile Road, Fort Piere, FL
The lumbing Works, LLC State License CFC1428419 SLC License 27092
Orig nal GC, subcontractor or owner/builder
Jam is Maggi Plumbing State License CFC1427541 SLC License 2491�i
New
C, subcontractor
Reas 'n for Cancellation
Unable to meet schedule requirements
The ' dersigned 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 a all claims of action for any rea which may arise as a result of his change of
contr ctor/subcontractor or cancel f permit. A permit Cann a ca e i rk has been performed.
OF OWNER (or
PRINK.' NAME
State ilf FlWCountyLucieCounty
The f' lo acknowledged before me this
da20_, by
who is personally known to me
or wh as r uced as,ID.
04/30/2019
SIGNATURE GENERALCONTRACTOR (or new GC, as applicable)
PRINT NAME �}iiA f? C z- :s ,�� o A /S
i
State of Florida, County of St. Lucie County
Tliefollowing' "ment.wasacknowledge before met is
0W day of 20A, by -eS
�errlS who is personally known t
r who has prod, is ck as ID.
4/30/2019
Signa a of Notary Date Si ture o otary Date
;�4.+•.' JULIE J. GUETTLER
MY COMMISSION # FF923607
Revised 04/15/16 EXPIRES October 31 2019
140!)398-01b3 FkxW&NMfvServhm.corr