HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT S:
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
5�
C IVED
JUL 3 2019
Permitting Department
St. Lucie County, FL
BY
LEA F
ELECTONE OF T OLLOWMG: St. Lucie County
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.
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: —1 f 1 al Permit Number: f 9 C)s l C)O 3g
Site Address: 5a�35 C�tklandLGiceCircle,Ft'tercc ,F� 3`i°IS)
Qc�OPC �YY�l�k11 L)�C K State Licens;LRC05j&ISLCLicense 9_
Original GC, subcontractor or owner/builder
5bo+t- tames +abet- State License C.&Z I -1157 SLC License
New GC, subcontractor
Reason for
-(—�1e—(-
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 play arise as a result ofthis change of
contractor/su Zntractor or tion of permit A permit cannot be cancelled if rl t been performed.
SIG14ATURE OF tt// ER or owner/builder) SIGNATURE GENE CTOR(ornew GC, as applicable)
PRINT NAME Xe l'Y Torn 1 i nson PRINTNAMS 3ames
State of Florida, County of St. Lucie County
The following instrument was acknnoowrialged before me ads
(S.--t--day of-10k 4 20nr.byALe3�-h
li7 'Yl3ov-� whois 0ersonallykn tome
who has prodduced n ID.
-7/ 1 I Ig
Signature of Notary Date
Revis
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tate of Floridabertn GG 184517/2022
State of Florida, County of St. Lucie County
The foltowing instmmentwas aoimowledgei)7efom a this
15Fday of-1JT 20-0by ``S
'rabe.e who personally o
c or who has prodReed 0
Signature of Notary Date
And Notary Public State of Flontla
Andrea Lambert
%My Commission GG 114517
ma Expires 02/2012022