HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 `SCgN/V
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CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT'- Ou hk
PLEASE SELECT ONE OF THE FOLLOWING:
C 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
commencing 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.
-se— 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: c31 A I GL n Permit Number: 1512-0160
Site Address: 7767 SE HIDDEN RIVER DR
J � 8 8 oat l' hs State License C( G i ffl SLC License
Original GC, subcontractor or owner/builder
WILCO CONSTRUCTION INC
License SCC131151026 SLC License 29115
New GC, subcontractor Reason for Cancellation Ce,-1ti-AC- W- WA-5 Ml1Cl6/e- t/y O C,Dmplet°L 42- JA
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contra r/subco tractor can ellation of permit. A permit cannot be ca a work has been performed.
S GNATURE OF O R (or owner/bnilder) (/_ SIGNATU •NERAL CONTRACTOR (or new GC, as applicable)
PRINT NAMF Y)MQ17CyPRINT NAME ROBERTWILLIAMS
State of Florida, County of St. Lucie County
acknowledg y�efor: me this
2d� by-QP QL&A
_who is personally known to me
.i is as ID. / ,
CARLA I. COULTER
ia.,
Notary Public - State of Rarlda
.
-
Commissentr GG 142441
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M Comm. Expires Oct 30,2021
MyComm.
State of Florida, County of St. Lucie County
The following instrument was acknowledgb�fore�m, a this
day/of�rflall"M_, 20-ft, by [.I —
1l II W f W who is personally known to
me or whohastbroduced as ID. .
of Notary
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SION#GG16'p49Decelltber17,2021
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