HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
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 THE FOLLOWING: BY
xxx St. Lucie COuntty
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.
9800 : 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:
6-12-2018 Permit Number: 170E-0661
Site Address: 9800 5 OCEAN DRIVE, JENSEN BEACH, FL 34957
MICHAEL ROBERTS, SPECIAL FORCES
Original GC, subcontractor or owner/builder
RESTORATION BY GOLDEN CONST,LUIS F LIBREROS
New GC, subcontractor
Reason for Cancellation NA
License SLC License
License CGC 1510734 SLC License
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees of damages arising from any and all claims of action for any re soq which ma"as ofthis change of
contractor/subco ctor or cancellation of permit. A permit cam Lh rme .
S GNATt1RE OF OW1,1911
/(or owner/builder) / Si A G AL ONTRACT (or new applicable)
PRINT NAME l�D(pQ�T /CG P�e//�feK �eT P NAME 1
State of Florida, County of St Lucie County
The following instnuncut was acknowledged before me this
12-daa of 201g' by O&-YT
�J t^ who is personallyknown to me
or who has produced/) _ as ID.
Date
Zt�,
MARY E RICHETELLI �- �p? -� 8_0110tul(PObllc. State of Floridaa My Comm. ExpJes Jan 20,1-1.Commission a FF 1636:
State of Florida, County of St. Lucie County
Th following instrument was acknowledged before me this
a7.dayof9 441.1-- .20Mby Lt115
l.J h r lOr'05 ^ who is mo onall0nown to
me or
u
Date
WR1,''1, MARY E RICHETELLI
Notary Public . State of Florida
•e My Comm. Exptres Jan 20, 2019
Commission N FF 163621