HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORa
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
• 2300 VIRGINIA AVE RECEIVED
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 JUN 0 5 2018
ST. Lucie County, Permitting
ANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
SCANNE®
PLEASE SELECT ONE OF THE FOLLOWING: BY
CHANGE OF CONTRACTOR— Change of Contractor is to be signed and notarized by the St-�1J9lg Qqunty
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 valu ter than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
comet 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 Sab-
Contractor.
CANCELLATION OF PERM[T — 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: CO Permit Number;; � " - �y n
Site Address: 6 d
License SLC License
Original GC, subcontractor or owner/builder/
,�/� G�i..ul�'?�:'•r!� State Lice O�.i/3 SLC License bb�9
//New GC, subcontractor djV-1,51`1l 4,
Reason for fancettaaon
The undersigned does hereby 89ee to indemnify and hold harmless St Lucie County, its officers, agents and
costs, fees or damages arising from any and all claims of action for any reason, which tray an nitre
c
on
t
ractor/subcontractor or cancellation of permit. A permit cannot be etmcell es been
SIGNATURE O�or owner/builder) somqWWRE aRMLAL CONTRACTOR (or new GC;
PRINT NAME �) ( Y1 r-Arn-1— V t'lA^(L -41 e l l0 PRINTNArds-�� A v i CA C r P:
State of Florida, County of SL Lucie Co®ty
The following insMwent was aoatuwledgad before me this
5 day ofStt. R = 201 by
V1niCb3i- �i112CELUrwt�wnois enondlykia tome
;t.oe-I rys-
wha has produced—
Z 4
( Slbmmtare ortY Date
state of Florida, Counlyof St Lacic County
as
The following ioatrummt wasaclosWocl8edbefore me this
.l dey of SkN3 jr— -20-S&by��,e`Jsh
oaallyknomm
me orwho hsa produccdd-�&i'—aa ID.
ell�
from all
e of
sigoaasre of N yry Date Gm/ UA r2G) t'id-
��;c+'='� M
Z0UEZ ELLYM. ROF-0-
My
Revised 04/1511 ia'��'�•�", 3e`�i Nate of Florida YCONtMi� .ma
:�E Commission 189&47 Eo:m
EXPIRES: Mm�2r
''';Fo,;�oFf s Feb 26,2022
" iondedal Notary Assn.
a
Jan.19.2017 08:50 AM '-_ '1c Builders ina 952 86tL- PAG
n < a • r . .• : PLANNING & DEVELOPMENT SERVICES
• 'y iY�r!'.'e v YWOW^Wr
y BUILDING & ZONING Mar ISIGN SC /ftE
rF • 2"0 VIRGINIA AVI,
PIERCE,FORT FL 34982(712) 462-1553 FAX 462-1S:S St Lucie a✓oUnt�
CyA 0 CIF CONTRAC= SUBCONTRACTOR OR CANC&,JAUQ OAT F PERW
"AFA SSr Fm ONB OF u OLT n'm
CHANGEOFCONIVA.CTOX-ChalwofContractorWr,
and the new contmaor ofrecord for the cuaent permit. A am perntit application must also be completed with ne'v
anntra"I id4 mation aM al gaature. A new Nofiw of Com wrremaeM must be filed is the new comcWs : me! a
for job values Stouter than $2,500 ($7,500 if A/C Change -out); A recorded copy must be submitted pri Y It;
mmim my work. Thera is a MOO for theCh=W of ConLntttor.
CIIANGE OF SUBCONTRACCOR — Subcotrtmotor changes are to be completed b+J the Somal coatn 9t11 r.
The now subcontractor must Sll out a SubcoatrA tmr Agreement Foal. There is a $30.00 fee for the Change of iul r
Contractor,
CANCELLAIMON OF PERMIT — The oancellaton of a pernfit is acceptable only if no work has been or. t.
Cancellat?oa of rermfl is * be eiped Rrd nobuiaipd by bath the ownerand qudifrcr of cornea. TResab no fe : E; If
cancellation of the permit.
Perm NNmutwr. �GO ly^ b t'ia
SiteAddresa g0 (7; ���Y 7 � � /ytr Z ,4,0; i�f :
8tam Licmrao SLC Llcatac
Od pal d7C can ctor r ownedbuMer
/7 QyG (.J!Ml emri0Ars StaraLieenso ttLeLiaeAwe _
New GC, cuboonlractor
RcesanforCenaonation l7t?l' pwivC►4
xd, or
The undersigned does hereby agree to imdemnifyaod hAld hataa4+re WE—' County, its afRmra, agcanand enrpfoyeca flnm all
Wani=ardamagosorisingfommymdAclabn6ofaottonfbr n,whec d awsldtafthkdoetgoof
rJlmgetedalmeenIlncrnr or canedtation of permit A permit ate aeett . n mrrerm4
swxAmm5pO/w�Nmt *r-;WZ sir f1 CO A a(arnew(le mi
Parax creme l✓Grvlf7 �J wy/�� Gc ImnrrxAhffi
sw*dp dlb6 cum of at raeiecamv Slmoarrladeo, famty ofSL 1"16Comely
iLefdlcaioaia9vmmtvnt+damrleEaedea&mmelhit 'Iha folbwinaAwMmme cos M1aNmmelMs
j1 dgra 2D-a bi Iq± 6eydf: 0aa1r1a1L, lom
vrhoSepesmelly�aaatoma L%dtts aw .who lap®md�.kov+nm
lmsproamel��a� �mC1oa1•ltas•1o50Til7 aep[ Iqa ■e ID.
A.
i
Revised 04/13/16
Notary Public • slate of Florida
My Gomm, Eeplrol W 20. 2011
Cammlaalon ArP 177249
ty RHONDA LAM ;'I' Y
MY COMMISSION# GG 1611120
EXPIRES January Oa, 20::1
J3n.19.2011 04:55 PM Rawk __ilders inc 952 8608
PAGE, 1/ 1
PLANNING & DEVELOPMENT SERVICES
8WIDING & ivNu IG iar'ISK). 4
• 2300 VIRGINIA AVE
FORT PIERCE, FL 34992
(772)462-15..13 FAX462-1478
h., c � N.. ► , ha � Y.t : t � F t.4.Y_:: i ' s ' _ t ,� � •' _1 .C:uY.
SCANNED
St LucBY
e County
CHANGE OF CONTRACTOit+Change of CQRUWor is tabor eigOCd and notarised by the MVerty oa tag,
andthe new osntfaotor ofreeord for the entrant permit A umw PmrAt application must abO be completed with rev.
contraew infbanation and signature. Anew Notion of Catmnerteemeat must•be filed in the new odnttadar's n mli
for job valucs,gWer than $2,500 ($7,5ba if A/C Change -out). A rmoot'ded OOPY must be subn-AW Prix t'
'.,n8 aayrwodt. There is a SWOfee forft Change of Contractor.
CHANGE OF &MCONCRACTOR - Subcontractor ohenPs arm to be completed by the general Coma to'.
The new soboontraotor must fill out it Subcontractor Agreement Form There is a 350.00 fee far the Change of i ub
Contractor.
CANCELLATION OF PERMIT •- The canoellatlan of a permit is acceptable only if no work lma been d tor!
Cmtcellssion of permit le to ba etgrted Smd notariaad by both ft ewneeead qualifier of record, Tiw+e 4 tea fr fr,
cancellation of the permit
Daw 1-15-�017
Site Address:
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Tbotallowmiioba®mtwas..�v.kd8odhefNametLit '/bC f9lbnd^E��„17
a�"d.yat 2glZby
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ra,.ve,,,..ed%4�d�1i. u%Ciagl•IlvSdo+7dS�''lj mrgrvd»bmPp@u+d _ rsm.
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8fa.dareofNotnr Nolnty Publk • State al Fladda
My Comm. Exprras On 20, Rota
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9XPIRE9 January 09, !O:! 1
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