HomeMy WebLinkAboutCHANGE OF SUBCONTRACTOR40
PLANNING & DEVELOPMENT S:
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-IS78
JAN 112019
ST. Lucie County, Permitting
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING: � SC BLAMED
CHANGE OF CONTRACTOR - Change of Contractor is to be signed and notarized••if kUmem ner,
and the new contractor of record for the current permit. A new permit application must also be complete wi ew
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
commee g
7any 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.
Date:
Permit Number: I%\ Q - () as �-!
Site Address: 52)U Ocxkaya I..GI(di(cle„ $t. �kmtl F
60q K C�(Ctn5, AL a2�.i�i i� l FJdAyyLState License Er,13004IRS SLC Licensed$ (Do7(P
Original 6C, subcontractor or owner/builder
Jt�l lli) Afhl� MCYnMQE(et)W(. State LicenseEC Q)005r 0' )SLC License 30Ck a3
New GC, subcontracto
i
Reason for Cancellation
The undersigned es hereby agree to indemnify and hold harmless St Lucie Coun , ' officers, agents and employees fror
costs, fees or ages ng from any and all claims of action for any reason, w may ar as a result of this change of
contr / ntract r cancellation of permit. A permit cannot be c work s been performed.
SIGN OF OWNER(or own�el ``e_r) SIGNA G NTRACTOi applicable)
PRINT NAME RbVJP_Ck JtY%%\VmASk(.K PRINTNANM �obe(kSm�nwj-t.oc-
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_q4,' day of iYil%t9
120 t J . by_&bekL_
QQK_'
_ who s personally known [ e
has
/who has produced
as In.
U�
1-CL-Lq
Signature of Notary
Date
Revised 04/15/16 re
o2f4FWlod7tl1
a
State of Florida, County of St. Lucie County
e following instrument was acl n Wledg a m me this
4M day of20}�, by
�
Date
�r�Wy Notary Public State of Florida
VNadia K Lefevre
7 � . My Commission GG 246771
son Expires 08/28t2022