HomeMy WebLinkAboutCHANGE OF CONTRACTOR - SUBCONTRACTOR - CANCEL PERMIT- I
PLANNING & DEVELOPMENT S:
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
V7
ICES
RECEIVED
JAN ? 2019
ST. Lucie County, Permitting
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATI
13Y
PLEASE SELECT ONE OF THE FOLLOWING: -St Lucie County
CHANGE OF CONTRACTOR Change of Contractor is to be signed and notarized by the property owner,
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
comng any wor k. k.There is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR - Subcontractor changes are t 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.
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:
i
Site Address: )QJ ncAy--lan �-�CGF-0C_ � � -��C, �L �L-i � � �
Oa\l `leLI+ -State LicenseF-C-il �u1a`� SLCLicense ab(Pab
Oi;ginal GC, subc ntractor or owner/builder
1 M crsoN L=1 PC,'f ri State License r-13OQ54 0c6 SLC License3 O q D3
Niw GC, subcontractor
Reason for Cancellation
ndersigned es hereby agree to indemnify and hold harmless St Lucie Coun , ' s officers, agents and employees from all
fees or ages ar' ng from any and all claims of action for any reason, w may ar as a result of this change of
/ c ntract pr cancellation of permit. A permit cannot be c c work as been performed.
NAME RC1nEkk 5MA WW<
of Florida, County of St. Lucie County
following qinstrument was acknowledged before me this
�� day ofJ�Yl, 20\, by _
UX% A1vlC \c J who s personally known t e
ho has Droduced as ID.
-OL -L.a
of Notary Date
I
Notary Public State of Florida
Revised 04/15/16 Nadia K Lefevre
My Commission GG 246771
Expires 08/28/2022
SIGNATLZL�'GEMRAL\C,`l/e ONTRt J
ACCT�OIZT \ 1A applicable)
PRINT NAME U (` — t 1N'Y 1W C
State of Florida, County of St. Lucie County
Te, Following instrument was acla'z�Qwledge of re me this
`1�m1d1ay of=` 20i1 by V
a 1W1 _ I who s personally known t
r��r 'r'who produtoex ,. ID.
�/i� 1-4 -► g
of Notary \ Date
Notary Public State of Florida.
Nadia K Lefevre
sg MY Commission GG 248771
�� Expires.o8/2&2022