HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORa
PLANNING & DEVELOPMENT S.
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CEIVED
JAN 1 1 2019
ST, Lucie county, Permitting
BY
PLEASE SELECT ONE OF THE FOLLOWING:
St Lucie County
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 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
commer�eing 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.
Thc*w subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
CELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
of the permit.
Permit Number: _i � II - 05 (p3
Site Address: 5c)I O OCiKIQn6 Lgl<e Clcde., ft, Pi e rep— F L ?,t J 9 5 1
QrV �C CtYISf P�(, G0D_U+t_1D6 4cstateLicenseEGiJD41R% SLCLicenseO'8(DatP
Original 6C, subcontractor or ownerlbuilder
J0\1V) fS'{YiMCn Nliyvtrn lSnyj E?1 fit? State LicenseLGl�jO0JY�O�SLC License 3oq a�
New GC, subcontracto
Reason for
The undersigned es hereby agree to indemnify and hold harmless St Lucie Coun , ' s officers, agents and employees from all
costs, fees or ages a ' ng from any and all claims of action for any reason, w may ar' as a result of this change of
contt / c ntract r cancellation of permit. A permit cannot be c worlt s been performed.
SIGN OFOWNER(0row \`e_r) SIGNA G \CONIRACTTO�� applicable)
PRINT NAME Rp�.C� �H`f\\tY\1J (-Y, PRINT NANM. SDLeC� J(: wmU Lx
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
4hd�sy of ,20L'L by
tilir�yl�n],C �C. who spersonally lmownt e
who has produced as ID.
Sigua[ure of Notary Date
Revised 04/15/16R
My Commission GG 240771
: Expire60S282022
State of Florida, County ofSt Lucie County
e following instrument was ackn wledge a re me this
N'' day of 20IN I
1W/� Ali IAA IA who s pemonally lmom t
rA who has produced__An M.
Date
ip�Oy"t6. Notary Public State of Florida
' t , K& My Co mission GG 246771
4Y rl Expires 08282022