HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPLANNING & DEVELOPMENT- SERVICES— - -- - - -
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BUILDING & ZONING DIVISION
2300 VIRGINIA AVE' SCANNED
(7772) 462-15 3FORT E� FFAX 462-1578 L 34982 St' Lucie Count,
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERNIT
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
commen ' g 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 PEPMT —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: T f/ °� Permit Number: /�f/J
Site Address: S1 rfi-D !mil �t/n/it/ ZL / / D n e,--
Cfltate License SLC License __72
Original GC, subcontractor or owner/builder
_5(/.y4.q . C- G State License SLC License oWS3
New GC, subcontractor
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 or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME 21jE-rLi /LJ /tL�%ZL� PRINTNAME
State of Florida, County of St Lucie County State of Florida, County of St. Lucie County
�The following instrument
was acknowledged before me s
LA day of4�3 20 t 1,by
who is personally known to me
yr{yyro has produced L 044� MID.
fl 1 t S
Signature of Notary Date
Revised 04/15/16
The following instrument was acknowledged before me this
_day of 20by
who is personally known to
me or who has produced as ID.
Signature or Notary Date
PLANNING &-DEVELOP-MENT-SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
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
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
commencin y 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 $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: ��o� �Q1 Permit Number: 1901— e37a
SiitteyAddressc:; SeO 0y,/n' ` �/ -R&1Cir
`
yllt6i-�( State License SLC License 30(q�
Original GC,
Isubcontractor or owner/builder
P ( State License SLC License 2J7S5-
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fror
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
con r/s onuactor orc permit. A permit cannot be cancelled if work has been performed.
S GNATURE OF OWNER (or owner/builder)
SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
ii6
PRINT NAME /G o e' -L /,I 862 -L� PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of- 20_ by
who is personally known to me
no has produced as ID.
rgnature of Notary Date
sa"n"�,. IASFiANNA INGRAM-RAHMIN G
I . - ' MY COMMISSION # GG 275M
Revised EXPIRE$:Decembeft,2022
,,,!;P BOIIded7lrU Nofdy PahBellndawNeB
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of- 20 by
who is personally known to
me or who has produced w ID.
Signature of Notary Date