HomeMy WebLinkAboutCHANGE OF SUBCONTRACTOR. -V_
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION LRECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 N 112019
(772) 462-1553 FAX 462-1578
county, Permitting
'SASE SELECT ONE OF THE FOLLOWING: St LO Y
_CHANGE OF CONTRACTOR - Change of Contractor is to be signed anAggr%114jhe property owner,
the new contractor of record for the current permit. A new permit application must also be c"dmpleted with new
tractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
unegeing 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.
new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
CANCELLATION OF PERMIT - The cancellation of a permit is acceptable only if no work has been done.
ation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
ation of the permit.
Permit Number: r � I � - %5 C10cp
Site Address: ((��533 p `�yC\QYI�,m`.A`kk .Gf csA, -tom 1 if -C-, IF L _ 3
� Gi iN K L-V a m, , AU),n I'C4 State License E(13 W41 r)R SLC License 0'U9o'i (o
O�riginal G , subcontractor or o er/builder 0 e `c,
3 01)1n �taNC lSDn State License G 0 2)M54(DSSLC License 30C1 D3
New GC, subcontractor — , a �
for Cancellation
ndersigned es hereby agree to indemnify and hold harmless St Lucie Coun , ' s officers, agents and employees from all
fees or ages at' ng from any and all claims of action for any reason, w may at' as a result of this change of
c intact r cancellation of permit. A permit cannot be c c work as been performed.
OF OWNER (or, owneQQ \ `e-r) SIGNA G ONTRACT( applicable)
r NAME Rp\(A�Ck J(Y\\iyl W'< PRINFNAME iZ0oeC�-5cnMnwyLx
of Florida, County of St. Lucie County
following instrument was acknowledged before me this
in day ofJ�Rr�'i .tom 20 O by
of Notary Date
04/15/16 av � pJadra KLefeVre of Fladoa
g��, g My Commission GG 246771
orw Expires 0a/29/2022
State of Florida, County of St. Lucie County
Ve following instrument was ackedge of re me this
day of 20N Ni !
1(}�pVJ11 AC who(,-- ersonally lnowno
Date
apt Notary public State of Florida
Nadia K Lefevre
"�c g My Commission GG 246771
�w Expires OW&2022