HomeMy WebLinkAboutCHANGE OF CONTRACTORCHANGE
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and the new contr
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commencing, any
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The new stibconti
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Can¢ellationlof A
Date: 1
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iite Addre
PLANNING & DEVELOPMENT SERVICES
I BUILDING & ZONING DIVISIO RECEIVED
2300 VIRGINIA AVE
1 FORT PIERCE, FL 34982 J U N 2. 8 2019
(772) 462-1553 FAX 462-1578, Lucie County, Permitting
orvr,Ltlt tlfe6x
OF TBE .oLiow>NG St. Lu a County
CONTRACTOR — Change of Contractor is to be signed and notarized by the property own
ofrecord for [the current permit. A new permit application must also be completed with ne
and signature. A new Notice of Commencement must be filed in the new contractor's nar
-than-'$2,500 ($7,500 -if. A/C Chalige-out). A recorded copy -must be submitted prior,
There is a $50g00 fee for the Change of Contractor.
SUBCONTRACTOR = Subcontractor changes are to be completed by the general contract(
must fill out j a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Su
[ON 01� PERMIT — The cancellation of a permit is'acceptable only if no work has !been dor
is to be signed and notarized by both the owner and qualifier of record. There is no fee f
Permit Number
it f 1l v 11A ILae_ C i t-r \P
urrgrnat tic ; suoco tractor or
New GC, su8contrac or
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Reason for Gancellatio
The' undersigned does ereby agrt
— Cost{s; fees or damages Irising fret
conlrncto subcontract r or cane.
'§1bNktUff9F0wltRi r ownedbr
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-------PRTNT--NAME '1. --Y
State ofFlmida, ICIounty�of Lucie Cow
The1 followingv u it aclmowled7
µ aye _ _ 20 67
o is
o who has Produced as
Revised 04/16/16
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State LicenseCR CO 3-11 SLC License a S 91 l
milder 1
State License QGU 511 157 SLC License 3 a 45
udemnify and hold'harmless'St Lucie County, its officers, agents and employee's from all
and all claims of action for any reason, which may arise as a result of this change; of
lof permit A permit cannot be cancelled w has been performed.— —
I '
SIGNATURE Gc ONTRACTOR (or new GC, as applicable)
ISDh--•-- --- '--..—.PRrNT-NAME 3ameS Fah,-r
• State of Florida, County of St Lucie County
ire me this { - - . ,The following ment-was wknowledg before me this
I; .L {,. I { a]y--day of iAl4, . 20 by
y o ie—'fGC�C�eI�w0` erson y mown
me or who has Produced as ID. ' i
r_Pubiic grate of rioodo S' ature of Notary Date
Andrea Lambert
51
Commission GO 1647 Notary
Notary Public State i
`r"`s--- w��_QL'xPires 02J2012022
Andres Lambert
My Commission GG
Expires 0212=022
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