HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
2300 Virginia Ave.
Fort Pierce, FL 34982 ST. Lucie County, Permitting
(772)462-1553 Fax 462-1578
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CHANGE OF CONTRACTOR SCABYN
Or Subcontractor or Cancellation of Permit St. Lucie County
Change of Contractor is to be completed 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,
signature, and transfer fee. 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. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date:
Site Address:
122 Al A
Permit Number: l qc>/— 05#3
C&er, o A r it AQCo State License � 1. 0074bO SLC License 9/ 2-
Original General Contractor (or Subcontractor)
/ QG�ges State Licensea00/1�1f/0 SLC License 03
New General Contractor (or Subcontractor)
Reason for Change
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. �n
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SIGNATURE OF OWNER (or
oownnerlbuil/der)�c n ' SIGNATURE OF NEWS GJENNERAL CONTRACTOR
y-� n �1
PRINT NAME V -T G/ V12 O%-�1 /('1 PRAITNAME i, o-4 1- � � L JT�r�G0
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following msstmment was acknowledged before me this The following instrument was acknowledged before me this
day of f-+AQ/L 20fT by ri -92day
yof 0 ;L' 201tby t/33
rho is personate ow to me ho is pem null ow to me
or who has Ptoa'ia�a�ii� pV a or who has prodnced as
Signature of Notary Date Signature of Notary Dare
*Only sign u quir subcontractor MfipU01AZ
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Revised 07/21 r �. CemmMShltotFkrftl� ?= Ntg1/6GOSS017
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WY Comm. E rplr•tC# ltl13, 20 2020
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COUNTY
F L o R- =i D. A
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PLANNING & DEVELOPMENT SERVICES e
BUILDING & ZONING DIVISION
- 2300-VIRGINIA-AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR. SUBCONTRACTOR OR CANCELLATION OF PERMT
SCANNED
PLEASE SELECT ONE OF BY
THE FOLLOWING: St. LUCIt; 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
cc encing any work. There is a $50.00 fee for the Change of Contractor.
7V 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: �D��B l / Permit Number:
SiteAddress: T 2Z A) &
/
title✓ f� e Al State License SLC License
Original , sub/c'o_ntra�cto r owner/builder
?gYf �W Ak4 � 5 �t47"9 State License �f/176�%g 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 may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if wor c-L s be erformed.
N
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL OR (or new GC, as applicable)
PRINT NAME PRINTNAI
State of Florida, County of St Lucie County
The following instrument was acknowledged before me Otis
by
is personally (mown to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
State of Florida, County of St Lucie County
The fo owing mstrumentwas acknowledged before me
day of C)E�K .20� by t�
who is personally (mown to
me or who has produced a
4i .. ELLEN VAUGHN
sSrate of Florida -Notary Publi
Signature of Atary Dat '-• c Commission # GG 270079
My Commission Expires