HomeMy WebLinkAboutCHANGE OF CONTRACTOR - SUBCONTRACTOR - CANCELLATION OF PERMIT1
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PLANNING & DEVELOPMENT SERVICES R"CF
BUILDING & ZONING DIVISION �0®
_ 230.0 VIRGINIA AVE DEC 1 ?U�g
FORT PIERCE FL 34982 Per t! Lit 9 De
(772) 462-1553 FAX 462-1578 �' � t'c/Q Qau�4o
CHANGE OF CONTRACTOR. SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR - Change of Contractor is to be signed and notarized by the propeq, onelr�ty
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 $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.
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 -
Contract .
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:
Permit Number: __L2 Uq — C )to& O
Site Address: ED `] 1 Oca l o hd L ck e, Urck
1yy R 1-n 1 �- Cj n kon--Q S State License C, �(,05-1%11 SLC License.) 81i k -]
Original GC, subcontractor or owner/builder -
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State License SLC License
GC, subcontractor
Reason for Cancellation iAouP' A --\_I o e (,h a n c, L n n LD}
The undersigns des hereby agree to indemnify and hold harmless St Lucie Cou its officers, agents and employees from all
costs, fee d1h ages ar' ng from any and all claims of action for any reason, ch may se as a result of this change of
coritrac or c ntrac ell ion of permit. A permit cannot b f wor as been performed.
SIGMA F O (or owner/builder) SIGNATU ENERAL CONTRAC ew GC, as applicable)
PRINT NAMEO�r� �(�n1ahW�C1L
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State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
O�h day of'�CCO-"1 IT, 20AS_, by P-QL0e
STY\O I_S_ l C,V _ who is ersonally crown: me
Who has pro duc as ID.
% 01 l Q J 1 %
Signature of Notary Date
Revised 04/15/16 L
, Notary Public State ofFlorida
Andrea Lambert My Commission GG 184517
w Expires 02/20/2022
C� V Wu : Ck 0r))i,LeA 5,u e
PRINTNAME t 'E .�� Sna:&S, /iA f Y�
State of Florida, County of St. Lucie County
The following instrument was aclnowledg d before me this
day of CernbPr.20)
by 110_)gClt�
J A41 V 1 �il�i�C
who is(rsonally lno to
n_lq or who has produced
as ID.
, C
0)
Signature of Notary
Date
Notary Public State of Florida
Andrea Lambert
$ My Commission GG 184517
Expires 02/20/2022
t7'�1 rl 1 a o &* 1 I�rrtYf fYV