HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORco y
PLANNING & DEVELOPMENT SERVICES RECEIVED
BUILDING & ZONING DIVISION Frg 1 1 2019
2300 VIRGINIA. AVE r, Lucie County; Permitting
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
'SCA�
PLEASE SELECT ONE OF THE FOLLOWING: `dED
CHANGE OF CONTRACTOR —Change of Contractor is to be signed and notarized by the pt�yyeer,
and the new contractor of record for the current permit. A new permit application must also be completed with 19unty
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
comme 'ng any work. There is a $50.00 fee for the Change of Contractor.
XX 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.
Date: �� �5 Permit Number: 1"1 � � �3
nSite Address: 5 30 q PaKland Lalst C i� c 1P, -t-or Pceccff , L `3'4q 5 1
l naN R EVMS I NC®Q\N C12C,�Y G State License SCk SLC License ab(DQ i`y
Original GC, subcontractor or o er/builder
Johh Af Vr &Mt i �_--7 bYYI.c"1(1.lm B2Cx,4 State License E03CCei [)% SLC License 3D9 a3
New GC, subcoit9ctor M,
Reason for Cancellation e �XRPA? 4 CM*01h)(_
The`
es hereby agree to indemnify and hold harmless St Lucie Coun 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 arm as a result of this change of
contra/ c ntract pr cancellation of permit. A permit cannot be c c work as been performed.
PRINT NAMEp1�P_��1tV\��.�
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
q l'� day of , 20A, by bOiA
PS wC_\C_ who spersonallyknownt e
who has produced on as ID.
k-C.-La
Signature of Notary Date
q9 Notary Public State of Florida
Revysed 04/15/16 t� Nadia K Lefevre
My Commission GG 246771
Expires 08/28/2022
;IGNATIaU'GI�R.AL G!ONTRACTOR \ � applicable)
PRINT NAME ��e C �MF 1WCC
State of Florida, County of St. Lucie County
T e ollowing instrument was ackn wledg ' of re me this
"1� day of20 �, by�
,S% who's personally known t
erp�r '1 " who)k producedIj as ID. I
® 0lam. -1 'i
of Notary - \ Date
Notary Public State of Florids
Nadia K Lefevre
My Commission GG 246771
It Expires 08/20/2022