HomeMy WebLinkAboutCHANGE OF CONTRACTORft
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 APR 3 0 2019
(772) 462-1553 FAX 462-1578 sr. Lucie county, permitting
CHANGE OF -CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
SCANNED
PLEASE SELECT ONE OF THE FOLLOWING: BY
St. Ludg Count
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the l erty owner,
ana 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: �1AY h S Permit Number:ygr, r ,Lq5
Site Address:
�c�i State License SLC License
Ori coal GC, subcontractor or owner/builder
0 vie t- 1 J State License SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which ay arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be elled i rk has been performed.
I
SIGNATURE OF OWNER (or owner/builder) SIaeppl+ee6W—
PRINT NAME Alf\r .r_ PRINT NAME
State of Florida, County of St. Lucie County
Revised 04/15/16
State of Florida, County of St Lucie County
was ackn wledg before meth is I The following
20� by',.�Lrl'� � ay of
_,
_who is personally known to me �8 . %
Signature
to