HomeMy WebLinkAboutCHANGE OF CONTRACTOR - CANCELLATION OF PERMITPLANNING & DEVELOPMENT SERFICESRECEIVED
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE 1 2019
FORT PIERCE, FL 34982 nty, Permitting
(772) 462-1553 FAX 462-1578
CHANGE OF
PLEASE SELECT ONE OF THE FOLLOWING: 0' ���'�
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CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property ov lif lilt
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
comma 'ng 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 flew subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor..
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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:
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Original G , subcontractor or owner/builder Sk c-"'
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New GC, subcontractor Lve C;k � L
for Cancellation �/1 t
The undersigned es hereby agree to indemnify and hold harmless St Lucie Co un , ' s officers, agents and employees from all _
costs, 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
contr / c ntract r cancellation of permit. A permit cannot be le work s been performed.
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SIGNA OF OWNER (or owne `,e_r) SIGNA GE ONTRACCT�O�R (i applicable)
PRINT NAME_yzcocyk S(`l�\1-Y\�JJ�C PRINT NAME _ iZoyeC — Ji yiA1U I.ilC..
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this T e, {ollowing instrument was ackn wledge of re me this
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W, h�d�ay"of-'A"WDA , 20� by ` b It day of 20 by.
SCA W,C Q who s personally known t e �� Iw1
who has produced as ID.
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Signature of Notary Date
sop Notary Public State of,Fiorida
Revised 04/15/16 Nadia K Lefevre
My Commission GG 246771
oo� Expires08/28/2022
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State of Florida, County of St. Lucie County
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nature of Nota Date
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