HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
°i 2300 VIRGINIA AVE
FORT PIERCE, FL 34982 SCANNED
' (772) 462-1553 FAX 462-1578 BY
St Lucie County
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWMG:
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 fled in the new contractor's name
ford 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 S50.00 fee for the Change of Contractor.
x 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 S50.00 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: 01/0412019 Permit Number:,
Sitei Address: 1Lb�f�
Meeks State License CFC057372 SLC License
Original GC; subcontractor or owner/builder
PJdgeway Plumbing I Gregory Kazan State License CFCD'n� SLC License
New GC, subcontractor
Reason for Cancellation Meeks is off the Job
any and all claims of action fiat any reason; whit ' ; ' r se
costs, fees or ' `gas arising:from result of this change of
contractor' ontractor or cancellation of permit. A permit cannot be cancel .if w be performed.
SlONATURE OF OWNER (or owner/builder)
SIGNATU— .GE CTOK (or new GC, as applicable)
PRINT NAhz Brian W Davidson
F NAig' , regory Kozan
state!orFlonda, County of St Lucie County
State of Flands, County ofSt Lucie County
The fallowing instrument was acknowledged before me this
The following instrument was acknowledged before me this
G4 Liday oc January 20 ra , by
a day or n 20 Is by
Pt;esanally known who is persomily known to me
personally knovm who is personally known to
or ha, produce - as ID
me r who has propdu,ced1_ as ID
T' 01/04/2019
4/2019
iture of Notary Date
Sigaat re of Notary pate
Revised 04/15/16
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