HomeMy WebLinkAboutCHANGE OF CONTRACTORRECEIVED
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PLANNING & DEVELOPMENT SERVICES APR'W1019
BUILDING & ZONING DIVISION permitting De'a
2300 VIRGINIA AVE St'
Lucie Counryent
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 SCANNED
By
'St• Lucie
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
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.
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:
Site Address:
Il
Permit Number: 10 — oO
73
ML Ji + le l Y4!Wa r 'State License W ti3 SLC License
Orriggii— ai�ub`c/ontractororo t�i ui/ it ePr�'
1(- / Sy[ Q f , G\L State License hdl_ SLC License a 4o1I %
New G , subcontfactor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
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
contractor/subcontractor
ctor cancellation of permit. A permit canno ance0ed if work has bbeeeeny performed.
SIGNATURE OF OWNER (or owner/builder) SIMAIM GENfRAL CON R (or new GC, 4 4pplicable)
PRINT NAME�A)l G,r. L7, ���T�tq�
P.V. :jr) V
sn OC-Y�C.\I
State of Florida, County of St. Lucie County
State of Florida, County of St. Lucie County ,
The (following instrument was acknowledged before me this
a R of 20j, by W t (11/h
Thhe�following i em ackp�,wlodged befo me this
ZLday of rn 20J�, by " _0q
daay ,
HISS t T tQif /1Ge A ro m pe) n. y wn to me
/
who is personally known to
o o
ced as ID.
me or who has produped as ID.
Signatu Dat /
Signature of Qtary Date
:otp�rooGc EUGENEDJAEGER
Commission# GG 144661
Revised 09 /15/16�,i o Expires January 20,202
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GIPIGER
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P HdiSTER
',°� MY COMMISSION tP FF912939
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"^a!t EXPIRES Auguet.25, 2p19
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