HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORFP'•
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
SCANNED
BY
St. Lucie County
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.
xxx 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
t:,:cancellation of the permit.
e 'Date:
Permit Number: / q0 'I - 03, ? ?
Site Address: Z -q-0 Z R -e 17 - ,
Electric Connection
Original GC, subcontractor or owner/builder
License SLC License 21055
AC Quality Electric State License EC13004128 SLC License
New GC, subcontractor
,, .. .
` .,, ` Changing Sub Contractor to
Reason for Cancellation 9 9
The undersigned does hereby agree to indemnify and hold harmless St Lucie Count4 Its officers, agents and employees fron
cdsts, fees or damages arising from any and all claims of action for any reason, whiPI may arise as a result of this change of
,.contractor/subcontractor or cancellation of permit. A permit cannot be cancelled ' work has been performed.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME PRINT
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of 20_ by
who is personally known to me
of who has produced as ID.
OR (or new GC, as applicable)
/ GRBK GHO Homes
State of Florida, County of St. Lucie County
The f flowing iri4°mjnt was acknVledged before me this
day of J LAY , 20-a by
William Handler wllo is personally known to
me or o It s produce ------ m m.
®s ig
Signature of Notary Date Sig a Date Rebecca 01ma
GOSp876
.�AtjuP(f�ri�
,_gp•....ay,�; gomttilssJa nary 9 2021
Revised 04/15/16 _ • x'2 Er.PlteS.(UoNOtary