HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORI
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE L__RFORT PIERCE, FL 34982 N 112019
(772) 462-1553 FAX 462-1578
County, pear
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCEL"Rffi PERMT
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
comme ng 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 mew 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:
Permit Number:
Site Address: 5D—I5 �iCt\C�QYL2`�LA%p-�tfG�e, FF.1�;�Fc� FL-3` PS
l_%QYV 9r—_Vctn5F ALag� k F1164 C:StateLicenseE(A3C QS SLCLicense 0S(Pc-7Cp
Original 6C, subcontractor or owner/builder 2
jow) w aynrn2g= Ek,&N't, State LicenseEG12)D05VZSLCLicense3og a�
New GC,subcontractto�
Reason for Cancellation
The undersigned es hereby agree to indemnify and hold harmless St Lucie Coun , ' s officers, agents and employees fron
costs; fees or ages ar' ng from any and all claims of action for any reason, w may as a result of this change of
contr / c ntract r cancellation of permit. A permit cannot be c c 'work as been performed.
SIGNA OF OWNER (or owneQ \ `e_r) SIGNA G ONTRACTO applicable)
PRINT NAMEry�
_ (3\AAP_Ck Ji�1\\tY\UJ\C� PMTNAME �abeC��GY1t�t�ullt.IC
State of Florida, County of St. Lucie County
20ial
who has
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this
"Signature of Notary Date
Notary public Stets of Flod
Revised 04/15/16 � vsR tla Nadia K Lefevre
�c�, My Commission OG 24W71
gw,dr Expires 0a/2a/2022
State of Florida, County of St. Lucie County
Z e following instrument was aclm wledge a re me this
4M� day of20by�
SOW Notary Public State of Florida
Nadia K Lefevre
My Commission GG 248771
"sooty Eupims 0a/2al2022