HomeMy WebLinkAboutCHANGE OF CONTRACTOR--)7
PLANNING & DEVELOP
BUILDING & ZONING D
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX
JUL 3 2019
Permitting Department
PLEAS ELECT 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.
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 PERM[T - 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. SCANNED
i BY
Date: `�. I Permit Number: 19Oa- 008(PSt. LUCie County
Site Address:5a59 oAIC1cmd CC,c.le- I1 I .P�cit_e- FL_ 3g6iS1
Re_�_Ck'F:tm 0(-�WR(_-K State LicenseC, O0_5 j_j�SLCLicense P 2 9 11
Original GC, subcontractor or owner/builder
Sego+fi dames al�er State License C612,L51-1)57 SLCLicense 3la%
y New GC, subcontractor
-Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
costs, ecs or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contracto contractor or cancellation of permit. A permit cannot be cancelled i o� ras been performed.
SIGNATUREO O'/ `orowner/builder) SIGNATURE GE /O/t CTOR(orneew GC, as applicable)
PRINT NAME ;iP, l Y' Torn l i nsoh PRiNTNAI'53�' r
State of Florida, County ofSt. Lucie County
The following instrument was acknowledged before me this
S� ya\s 2eL
l�y11 k; � n S an who i ersonelly kno � me
o has pmdu as ID.
�II�
Signature of Notary Date
Revised 04/15/1 yp CYw Notary public Statao/Flodde
Andrea Lambert
11 V My Commission GG 184517
EXirea 02l20/2022
State of Florida, County of St Lucie County
The following in' ment was ecknq led d before me this
day of .20 M by c.,r'F'\
o"O e,c
wh s personally kno Jto
rtvho has pmdu
as ID.
Signature of Notary
Date I
NoUry public State a/Florida
Andrea Lampert
�pg My Commission GG 1ag517
p 11� F-�1, 02/20/2022