HomeMy WebLinkAboutCHANGE OF SUB CONTRACTOR-73
PLANNING & DEVELOPMENT SERVI ES RECEIVED
BUILDING & ZONING DIVISION
2300 VIRGINIA. AVE JAN 1 1 2019
FORT PIERCE, FL 34982 ST. Lucie County, Permitting
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:�U
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the propeq cr&r,
and the new contractor of record for the current permit. A new permit application must also be completed with nwty
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
co' rnmqZing 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.
I
Date: Permit Number: 1 211-- 639 a
Site Address: _n51 QQ. QYW I Ltdj f-de-, F+ Pt'e rce FL 3 Lf q5 /
C 064'WI(:state License E(113CO41@S SLC License D 8 (Go7Cp
Original bC, subcontractor or owner/builder
i
O E 0. State LicenseEGQ)Q05W'6SLC License O Q,
New GC, subcontracto
son for Cancellation
The liundersigned es hereby agree to indemnify and hold harmless St Lucie Coun s officers, agents and employees from all
costs, fees or ageVa
ng fromany and all claims of action for any reason, w may ar as a result of this change of
contr�6t / c ntraccancellation of permit. A permit cannot be c nc work as been performed.
PRINT NAME
State lof Florida, County of St. Lucie County
The following instrument was ackriowledged before me this
� N day of�Y1l� 20�, by
1�i hA rC who s personally known t e
wh'o has produced as ID.
Signature of Notary Date
L
%.fNotary Public Stato of Florida
Revised 04/15/16 Nadia K Lefe to
My Commission GG 248771
Expiros 08/2812022.
I
SIGNATUW'GENERAYCONTR1.ACt1FTTO�R- l 1.ai! applicable)
PRINT NAME ? C�Q C - ✓t y Yu LQ_\L lC.
State of Florida, County of St. Lucie County
e ollowing instrument was ackn wledge a re me this
day ofy�20 , by
,�d m �1 who-s personally known t
w has
1 produced
Q / as ID.
of Notary \ Date
°ky_ Notary Public State of Florid.
F Nadia K Lefevre
My Commission GG.246771
c9' Enpires 08/20/2022