HomeMy WebLinkAboutCHANGE OF CONTRACTOR - SUBCONTRACTOR 2-11-19PLANNING & DEVELOPMENT SER
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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MAY 12019
Permitting Department
fit. Lucie County, FL
E OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATiO
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PLEASE SELECT ONE OF THE FOLLOWING: ,
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by tlieEhtopq ty owner,
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and the new contractor of record for the current permit. A new permit application must also be completed %k4V th 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
commencing any work. There is a $50.00 fee for the Change of Contractor.
XX 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.
$16°°^ 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.
Date: 2/11/19
q4t- Addrec.: 5144 Cherry Palm Way
Permit Number: 1$0
I
FTL Electric State License SLC License
Original GC, subcontractor or owner/builder
Blosser Electric
New GC, subcontractor
State License EC13001570
SLC License 20618
Reason for Cancellation
Tlie 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 i It of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancellediffW01 ns bee erformed.
SIGNATURE Of OWNER (or owner/builder) SIGNATURE GE: ERAL CONTRAC*)R (or new GC as applicable)
PRIINT NAME PRINT NAMEQ(%i l—
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State of Florida. County of St. Lucie County
I
Tlie following instrument was acknowledged before me this
day ol_ _, 20_by
who is personally known to me
or who has produced as ID.
2/11/19
Signature of Notary Date
Revised 04/15/16
Stale of Florida, COnnty of St. Lucie County
following iRstnlmei I Was ackc wledgcd beibre me this
lay ofi I 20L�j, by
o is per,, sa�to
o��v ruBvJOAN THAYER
a c . commww # GG 282897
* " Expires December 9, 2N2
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