HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORr
PLANNING & DEVELOPMENT SERVICES SCANNED
By
2300
O V GINIA AVE ZONINGDING & DIVISION St.Cuc e Count3,
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
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
'sfot job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
'"+ `
k,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.
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: %' 1 °/ � 1
Permit Number: / C912 — b SU Z
=Site Address: Z L S 7
Electric Connection State License SLC License 21055
'7 Original GC, subcontractor or owner/builder
AC Quality Electric State License EC13004128 SLC Lit
New GC, subcontractor
Reason for Cancellation Changing Sub Contractor to Complete
The undersigned does hereby agree to indemnify and hold harmless St Lucie County its officers, agents and employees fror
costs, fees or damages arising from any and all claims of action for any reason, whi4lmay arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled i work has been performed.
' 'SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of 120J by
is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
SIGNATURE
/ GRBK GHO Homes
State of Florida, County of St. Lucie County
The following ins rument was ackn ledged before me this
45P"day Wby
of ,2
William Handler who is nersnnally
known to
or has produce as ID.
/�'
Re ec a Dima
S
� GG06202�
"
ission
Comm
Janua
-�-�����'��
'
Expires:
on'NotaN
Bonded thro Aar