HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORSr.
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MELDING & ZONING DM5 OI N7Permitting
ELV
2300 VIRGINIA AVE N 7 Z019
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 Department
ie County, FL
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING: SCgN/v<C
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized b t" owner,
and the new contractor of record for the current permit A new permit application must also be complex elmii J 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 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: G 4 �� �� Permit Number:
013
Original GC, (subcontractor or owner/builder
) Cky- $ J ( ���c o Man �� N� �S to License C.%LAW 10t SLC License 1A Z 4 \ A
New GC, subcontra or .
Reason for
The undersigned does hereby agree to indemnify and hold harmless 1
costs, fees or damages arising from any and all claims of action for a
co tractor/subcontractor or cancellation of permit. A permit cannot
�SIGNAT(JRE OF OWNER (or ownerlbuilder) SIGN!
I
.ucie County, its officers, agents and employees fror
reason, which may arise as a result of this change of
-4)anceRed if work has been performed.
PRINT NAME UV Oil(; 1GY1. C�L�AM,tvWS PRINTNAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
'' day of ••A e— .201�, by i rAP
or
Revised 04/15/16
116A
State of Florida, County of St. Lucie County
ollowis twnm[ wasa'�^Im'powled to m s
day a 20W, by
me who is pets • y known
men roo
Si�atureob.
ofm ID
No
uubry
sl`�pAY P��p
Joseph Gomez
r`
Commission @ GG161404
Expires: November 16, 2021
%, oFR' ",
Bonded thru Aaron Notary
........AUDREYB.HUMPHRE'f
' ••'• ;, MY COMMISSION # GG 300817
^'• - EXPIRES: Match 6, 2023
ig
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PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION �cq
2300 VIRGINIA AVE
FORT
OR PIEL 34982
RCE,
FFAX 462-15780111)61
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
commencing 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: 5�� n - ( 1
Site Address:
Original GC, subcontractor or owneribuilder
New GC, subcontractor
Reason for Cancellation
Permit Number: l -!451- — ® I %IA
C G Cf�Q7'
SLC License
License SLC License
the u ersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
:ost , ees r dam es arising from any and all claims of action for any relson, which may arise as a result of this change of
o actor subc acilaar or cancellation of permit. A permit cannot. nce ed if or has been performed.
> GNATURE O OWNER (or owner/builder)SI ATURE GENERAI, CONTRACT`OR (or ,J new GC, as applicable)
PRINT NAME M(AY (Wt(I1 fAiti Cj(%IN
Wf'VI/.-S PRINT NAME 1 od J1 / ',
State of Honda, County of Sp-L-uctie6earuy 1 r & Aa Q:V. s-
The following instrument was acknowledged before me this
1-3 day of m ai 2017 by_n2A x iw,JIA.)
L L+=Ma J & who is personally known to me
or who has produced s m. rr
ignature of Notary ate
Revised 04 S o&c, BENCSAITZ
Notary Public-StateofFlorida
Commission# GG 101734
'�'T My Comm. Expires Jul 9, 2021
" o°n'O Bcnd=d through Nafionxl N.tagrkm.
State of Florida, County of St. Lucie County
The fol ng instrument was acknowledged before me this
ay of 2041 by
is personally known to
me or wl has produced % as ID.
Signature of Notary Date
HEATHER BURFORD
�Fz State of Florida -Notary Public
Commission p GG 183217
My Commission Expires
February 06. 2022