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HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORay PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION RECEIVED 2300 VIRGINIA AVE FORT PIERCE, FL 34982 JAN 1 1 2019 (772) 462-1553 FAX 462-1578 ST. Lucie County, Permitting PLEASE SELECT ONE OF THE FOLLOWING: BY 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 commerleing 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 $50.00 fee for the Change of Sub - Contractor. CANCELLATION OF PERIVHT - The cancellation of a permit is acceptable only if no work has been done. Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for cancellation of the permit. Date: Permit Number: 19 © I - Q l J rlo Site Address: 5oi8lo©GklgnO+LQIC2Grcl2,F+.PieC(e— (--L. �QYV F1C—.VCM5, A,GUD i,t-i-1_I06-6TCStateLicenseEf,130041a$ SLCLicenseDB(_P7 o Original 6C, subcontractor or owneribuilder JD1(W) ( f � J moynm lfrly t, State License EQ240506SLCLicense 3oC( a71 New GC, subcontractor-) Reason for The undersigned es hereby agree to indemnify and hold harmless St Lucie Coun officers, agents and employees from all costs, fees or , ' s ages a ' ng from any and all claims of action for any reason, w may ar as a result of this change of contr / c ntract r cancellation of permit. A permit cannot be c work as been performed. SIGN OF OWNER (or, own \ `e_r) SIGNA G ONTRACTOR applicable) �PgeriY\\tY PRINT NAME �IJ�� J\1N\C.K PRINTNAMEabet'��nriaMwtzic State of Florida, County of St. Lucie County The following instrument was acknowledged before me this �20t _ LJ, .by p]AAJ1CXl_ whopersollywe who has produced as ID. ,�:)— —s-rL-ta Signature of Notary Date State of Florida, County of St Lucie County e following instrument was acknj2 wledge5 a re me this Q V`�1day of 20JS, ! i 1/1}�1A�1�A� who s personally Imown t rpe qr who has produced J0 as ID. Date vvv0 Lfdi Notary public Stale of Floddsryuc State of Flodtla Nadia K LefevreRevised 04/15/16 ° MyGG 240771Enpu" 00/2012022 yR Expires 0a/2a/2022