HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPLANNING &-DEVELOPMENT SERVIN�4
BUILDING & ZONING DIVISION ,
2300 VIRGINIA AVE �'/ 1
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 14916
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
SCANNED
PLEASE SELECT ONE OF THE FOLLOWING: BY
St LUCIg (;ppunt;
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
commencing encing 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 -
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.
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Date: tO' Permit Number:
Site Address: 3 SS J3 ca-c K-e v) VA, 06-& St �u ci 9—� � f $-3
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�C j3oo:�3g3 4�
�� State License SLC License Y3
Original GC, subcontractor or owner/builder
Q &rlf a �, . State LicenseZ_ 6 SLC License
New GC, subcontractor
Reason for£oeen
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 from any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
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SIGNATURE OF OWNER (or owner/builder)
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PRINT NAME
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State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
I day of 20_, by
who is personally know"
or who has produced as ID.
of Notary Date
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Revised 04/15/16
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SIGNA RE GE CO no
PRINT NAME%r°C ✓�`
State of Florida, County of St. Lucie County
personally known to
of N KATHLEVNeANN HERRMANN
�' ` Notary Public - State of Florida
•a. Comm: Expires Sep 10, 2018
:•'� Commistion N FF 129910
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