HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DMSION
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
comme cing 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: _� • ) 9. ) g-
Site Address:
Permit Number: ) % 10 ) — o J` Ft,
I%C lam? Q Q /it 1 \. I ,� e i State License SLC License
Original GC, subcontractor or owneribuilder
�C IS�oO(o7?7
,-T,-+P r- -3t' on K ( State License SLC License
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 ma - 4rise as�yresult of this change of
contractor/subcontractor or cancellation of permit. A permit cannot, be cancelled if rl as en performed.
SIGNATURE OF OWNER (or owner/builder) GNATURE GENE Q - f(pclew GC, as applicable)
PRINT NAME PRINTNANIE 4q-&n IE. a,(L+h i er
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
by
is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
'Ih�follaawingy of instnun�ol� wlb5rAg re me this,
I e. lJ"Ckk+h f C r
�I ��.. whoisperson ly known I
me o vho has produced
cQa,.t/x Signature of Not Date V
AODREYB.HIM P WEY
+4 ' } MYCOtA MiON0003ON17
';a;;M1e!:rr Bpr,tedllW NotatrB.D^a