HomeMy WebLinkAboutCHANGE OF CONTRACTOR - SUBCONTRACTOR 8-19-19 - 2PLANNING & DEVELOPMENT SERVICE'S
BUILDING & ZONING DIVISION RECEIVED
2300 AqRGINIA AVE
FORT'PIERCE, FL 34982 AUG 19 2019
C772) 462-1553 FAX 462-1578 ST, Lucie County, Permitting
PLEASE SELECT ONE OF THE FOLLOWING: 63j luel, 0-
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CHANGE OF CONTRAcrm — Change of Contractor is to be signed and notarized `by the proper Y00
and the new contractor of record for the current peri-nit..A new permit application must also be completed with next/
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 (S7,500 if A/C Change -out:). A recorded copy must be submitted prior to
c . ng ariv work. There is a S50.00 fee for the Change of Contractor.
01 in cl
HANGE OF SUBCONTRACT01Z — Subcontractor changes are to be completed by the general contractor.
Sub-ontractor Agreement cot
e C sutic-_65_nfr��_t`ormus ill -out a cement form. There is a 550.00 fee forthe. Change of Sub -
Contractor,
CANCELLATION OF PEFMT -- 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: Z0 I Permit Number: 64!7
Site Address:
U State Licensc�3Q1 13 SLC License
Original GC, subcontract6r or owner/builder
l
el 3 �_C'_._State License SLC Li.-ense
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 frorn any and all claims of action for any rimson, wliiQh may arise as a resutt of this change of
contractor/subconuTewror cancellation of permit. A permit cannot b cancelled ifworkhas been performed.
cancelled
uilder) ACTOR n.-W GC, as applicable)
�NF L CONT�R
^_Y!RINT NAME RINT NMVIE
State of Floridk County of S Lucie County State of Florida, County,of St. Lucie County
The following instrument yeas acknowledved before m,.- this
allowing acknva'dedged before me this
20 -4ay of 2014,kv___
who is personally Rown to me ftab 0— 111ho is personally kno%n to
or who has produced r-Y 10 as 11). Me or 4� has pro e, F_L.,1b,
a, IUD),
_ A
Signature of Notary Signature of Notary—
KAREN S. NIELSEN
AUG�State of Florida -Notary Publi
tort PLL Ic Commission # GG 207484
25lu .7 My Commission Expires
r, J June 12. 2022