HomeMy WebLinkAboutCHANGE OF CONTRACTORi 0
PLANNING & DEVELOPMENT SERVICE
BUILDING & ZONING DIVISION RECEIVED;
61�2300 VIRGINIA AVE
FORT PIERCE, FL 34982 JUN;2 8 2019'
LI (7,72) �62-1553 FAX
AX 462-1578 ST. Lucie CoCounty, Perrtlittin
CHANGEIF:CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMTbUAMNEDI
I,
BY
the new
iactor. it
OF THE FOLLOWING: St. Lucie County
r CONTRACTOR - Change of Contractor is to be signed and notarized by the property owner;
of record for'the current permit. A new permit application must also, be completed with new
and,signature. A new Notice of Commencement must be filed in the new contractor's name
than:$2,500 ($7,500 'if. A/C "Change -out): A recorded copy -must be submitted' prior to
There is a $50.00 fee for the Change of Contractor.
SUBCONTRACTOR - Subcontractor changes are to be completed by the general contractor.,
must hilt out, a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub
i
[ON OF PERMIT - The cancellation of a permit is acceptable only if no work has been done:
is to be signed and notarized by both the owner and qualifier of record. There is no fee for
•nit. i � � � ,
Permit Number.:
tYSu�Yau)�c K State License C.057g_12 SLC License P 8q 1 1
Original GC, subcon actor or owner/builder,
G0i �QI SQ, r State LicenseCliCIS11157SLCLicense 31 f�xi'
i New GC; sulicomLc r; a r
n 1 Reason for Ca� cellatio � '
i I I
The' uridersigned does ereby agree, to in emnify and hold harmless St Lucie County, its officers, agents and employee's from all
- costs# fees or damages rising fromlany and all claims of action for any reason, which may arise as a result of this change of
contractor/'ubLontract' or c ellation of permit: A permit cannot be cancelled i or s been performed.
SI ATUREO OWN rowner/builder) SIGNATLRiEG C NTRACTOR(ornew GC,mapplicable)
I
-2R7T--NAM '� - ra�•I ln_ _ _ I._ _ .._ .;. __._.PRAIT--NAME- -L 3arnes f
State of Florida, County of . Lucie County State of Florida, County of St Lucie County
T�he,fo�l.kowing inshumerit-aclmowk itiged before me this- - - -Tbe following instrument -was acknowledged before me this
p�day of ,. 20 t 9 b M I1 nsDn a� f hday of ',30 nP . 201_ by 5
�,
w s enonall kn ome who' -personally o 0
or who has prod iced as ID. r who has �rogyced as ID.
LO a-7 h9 (za7�19
T
Signs are of Nofary Dale I i � � Signature of Notary Date
Revised W, /16 ; f`Fj, Nola' Public State of Florida -
• Andiea'Lambed •Ip�w' Notary Public Sta
d' My Commiss10h G'G 184517 ' Mdrea to of Fl°rida �
aw �xpires 02/20/2022 Lambert
' ' a w� Expires 02/ 1Op GG 184517
I 20/2022