HomeMy WebLinkAboutCHANGE OF CONTRACTORff
)UNTTY
L O 'R I D A'-'
PLANNING & DEVELOPMENT S1
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
JUL 05 2019
ST. Lucie County, Permitting
CHANGE OF CU NTRACTUR, S UBCUN'1'RAUTUR OR CANCELLATION OF rig Z
NO C
PLEAS ELECT ONE OF THE FOLLOWING: o%61
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 ice 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 $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: L / S / 1 9
Permit Number: / q 0 a O(D q 0
Site Address: _ S �) C�akictv�d Lcl C i f cJe FF r t�i e I c( FL, 3 `tI1 S )
ie. C'�CX'Co,7Y'r�t'c�"y,UFLK State License_GR C037a-1 I SLC License 11
Original GC, subcontractor or owner/builder
Sao+-f-.Tames F03�cr State License CGC1511)57 SLC License �)k 4.5)
New GC, subcontractor
Reason for
The undersigned does hereby agree to mdemnity and hold harmless St Lucie County, its officers, agents and employees fron
costs, fees or damages arising from any and all claims of action for any reason, which nay arise as a result of this change of
contractorlsu egntractor ity-caneeliation of permit. A permit cannot be cancelled/if rl it been performed.
SIG14ATME OF ER(or owner/builder) SIGNAIVRD GENB -`C•/j CIOR(or new GC, as applicable)
PRINT NAME TKe�l'Y TcnftSDn PRINTNAMRsCc,JCVTT3G1rnePS Fa4c-.r
State or Florida, County of St Lucia County
The fallowing in-sttrument was acknowledged before me this
i---S{t--F day of - t� 20lt by f' \ VQ
—Lt`i�i i Ylg raves who is rsonalfy kno m me
Cr,who hasproduced as ID.
1j 1 i 119
Signature of Notary Data
Revised �$ 16 Nomry pubpc State of Ronda
�fy,� Andrea Lambed
'jjn,��.°� ESP es 07120r2 22GG 18?51T
Side of Florida, County of St Lucie County
The following instrument was aclmowledg4before a this
1TF day of Z 04 204 by -=>L"Ftr
�0.102C who s personollYlmo � o
c or who has prod ced as
Signature of Notary Data
Nomry Public State of Morris
Andrea Lambert
,0• My Commission GG 104517
ryad" Expires 0212e12022
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