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HomeMy WebLinkAboutCHANGE OF SUBCONTRACTOR473 PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISIONEREC:EIV:ED_­__*2300 VIRGINIA AVEFORT PIERCE, FL 34982 1 (772) 462-1553 FAX 462-1578 nty, my J CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATIONkMWA T 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 commer1ei'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 new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub - Contractor. CANCELLATION OF PERMIT - The cancellation of a permit is acceptable only if no work has been done. Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for cancellation of the permit. Date: Permit Number: I� i a- 0 C)a 5 Siitnt�eAddress:5as3 oow;;ladI GltSkufc*Q ,PiA6taq I�QYV KC1OV)5,A .©OX%+L 00 ACStateLicenseE(,13()D ia$ SLCLicense DSCP ce Original 6C, subcontractor or owner/builder JOhVI eJmoMLnj� Wt, State License tG12)D05W`6SLCLicense 3OC(a3 New GC, subcontracto Reason for The undersigned es hereby agree to indemnify and hold harmless St Lucie Coon , ' officers, agents and employees from all costs, fees or ages at* ng from any and all claims of action for any reason, w may a as a result of this change of contr / c intact r cancellation of permit. A permit cannot be c work as been performed. SIGN OF OWNF,R (or ow z \ `e-r) SIGNA G NTRACTO applicable) PAINT NAME Rp1o�ck JM\tY\UAr_V, PRINTNAME iZobec�-5vion yuz, State of Florida, County of St. Lucie County The following instrument was acknowledged before me this '� of�Q�, 201, by�-t_ p ,% mday ��trr A c-k(-- who s:p rsonally known t e who has produce —d as ID. ` I-R-LA Siguature of Notary Date Notary Revised 09/15/16R MENxaypdCireioas2 o2P4F6lo7d7d1 a State of Florida, County of St. Lucie County e following instrument was iaclmgwe re me this day of y`,ry,by Jy*('NAA 20� by _ /S�l}WAAL_ who s personally mown t rye qr who has pmduced__,00,____as ID. er�¢ Notary public Stale of Floridan Nadia K Lefebre 2� g My Commisslon GG 246771 tiara Expires 002al2022