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HomeMy WebLinkAboutCHANGE OF SUBCONTRACTOR.J. PLANNING & DEVELOPMENT S". BUILDING & ZONING DIVISION 2300 VIRGINIA AVE FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 FEB 2 6 2019 Luple ceunwi Permitting CUC PLEASE SELECT ONE OF THE FOLLOWING: 01 Oh� CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owti€r, 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 Comm ncing 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. e new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub - Contractor. CANCELLATION OF PERNIIT — 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 tl a per it. / Date: Z 5 Permit Number: l f��zi 03 6 Site License SLC License 6 N Reason for Cancellation The undersigned does hereby agree to indemnify and hold harmless St 1 costs, fees or damages arising from any and all claims of action for any contractor/subcontractor or cancellation of permit. A permit cannot be SIGNATURE OF OWNER (or owner/build/err)),, SIGNATU PRINT NAME �Q,\rV �'l.� t q, 12 JJr lJ PRINT State of Florida, County of St. Lucie County The following instrument was acknowledged before me this 1'-fY_ day of t at C9_, 20, 19 , by (Y14{iiYtd �'c ilane/rJ who is personally known tome or whp has produced (� liL- �ID.� alp ll �gnature of Notary Date Notary Date Revised 04/15/16 LUCYWHEATLEY ME Notary Public - State of Florida Commission a GG 194104 '`•'.',Far n5' My Comm. Expires Jun 29, 2022 "Inded through National Notary Assn. License aS-eO6 its offic rs, agents and employees fron may se as result of this change of eor as b n performed. State of Florida, County of St. Lucie County The following instrument was acknowledged before me this y�\l. doy/of o� 20_,by LJY. to cl Aof e_s1 who is personally known to c,.,c,0 Kn.. me or w7so as produccd�7as ID. aL. I 19 Sig ure 0 Nomry Date RM LUCYWHEATLEY public -State o(Floridamission d GG 194704m. Expires tun29,2072gh National Notarygssn.