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HomeMy WebLinkAboutCHANGE OF SUB CONTRACTOR�Lp PLANNING & DEVELOPMENT SERVICESRE£EIVE© BUILDING & ZONING DIVISION 2300 VIRGINIA AVE FEB 1 1 2019 FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 ST. Lucie County, Pertrlifiifle CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT SCANNED .PLEASE SELECT ONE OF THE FOLLOWING: BY CHANGE OF CONTRACTOR — Change of Contractor is to be signed and n MYYFj l%g6rty 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 commeryzing any. work. There is a $50.00 fee for the Change of Contractor. 7,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: �;z I of i q Permit Number: VB 03% S Site Address: 5a7 % OakkeRv\.dA L-ak� (:Af-c.\es �cN­,- -9 r« '1"' 1-- 3 (naru R Evans, AC.0 tiltr 1=1ec f'Yir. State License603004kW6 SLC License a1(oaCO O`ri_gi al GC, subcontractor. or own r/builder ,�(7Y 1Y1 �� n�8 na, td,m�n Sor► [—� e G L- State License LLl5a05'� CA SLC License 3 0 2) New GC, subcontilaRor Reason for Cancellation 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 ccntr / c ntract r cancellation of permit. A permit cannot be c c work' as been performed. SIGNA OF OWNER (or owner \,e_r) SIGNA G ONTRACCT�OR_ T applicable) PRINT NAMEy'p�a-_Kk \�/�i1C PRINT NAME_ F1))Ve�� J(_yiP W)LUS— State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County The following instrument was acknowledged before me this e, Following instrument was aclm wledge a re me this day of i , 20 by _ L Yr+ day of :Tia��aC�20 by — �JrC_ J who s personally known t e j��}1y& J who s personally mown t who has produced as ID. a who has produced as ID. LSignature of NotaryDate nature of NotaryDate ,�° Notary Public State 0f Fiorids a?r°' Notary Public State of Florida Nadia K Lefevre Revised 04/15/16 Nadia K Lefevre ML Commission GG 248771 � My Commission GG 246771 EttPir®s o8128/2022 av� Enpires 08/28/2022 �ilflR}� �� g