HomeMy WebLinkAboutCHANGE OF CONTRACTOR53
PLANNING & DEVELOPMENT
)WELDING & ZONING DIVISION RECEIVED 2300 VIRGINIA AVE
FORT PIERCE, FL 34982 JUL 3 2019
(772) 462-1553 FAX 462-1578
Permitting Department
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCEtLA*4;oW-WEPfa=ty, FL
SCANNED
LEA ELECT ONE OF TM FOLLOWING: St, L U�B CO�t f lt�
CHANGE OF CONTRACTOR— Change of Contractor is o e stgn an 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.
CANCELLATION OF PERNHT — 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: I LI Permit Number: _ I/ O S— C)0 3 Co
Site Address: S 3 ("�kland LCtKK� Ci rcje. Ft =f 1 e,rce , FL .3 itlS )
RtkDcCkf2cdFtclnl,&)>3CA< State LicenseCRGO57Yj-1ISLCLicense P3911
Original GC, subcontractor or owner/builder
5b0+fi _-5C(Mes FG>.i> e (- State License WWII 157 SLC License :S l 2) l6
New GC, subcontractor
Reason for Cancellation U.,Y cf r(1w - of a) 0_9_ l 1 C (
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 Nay arise as a result of this change of
contractor/su egntractor�eetiation ofpermit, A permit cannot be cancelled if ti/rjl I s been performed.
SIG ATURBOF'/ orowner/builder) SIGNATURE GETCC�1 CTOR(or new GC, as applicable)
PRINT NAME*O EV Tom PRTNAME 15c_c4T3Qrnes Faber
State of Florida, County of St Lucie County State ofFlorida, County of St Lucie County
The followinginstmment was admowledged before me this
(�dayoff 20 tby-e:\E-4,
-=fa11 D2, ov-� who is 0lsonsllylm tome
Iho has pmduc as M.
J., 7 11 119
Signature of Notary Date
Revised
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The following instrument was aclmowledgedbefore alethis
lsfday of-TJ\20.0by, S
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eorwho hasprud ced as
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Signature of Notary Data
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