HomeMy WebLinkAboutCHANGE OF CONTRACTORL- J
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DMSION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
SCANNED
BY
St. Lucie County
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
I-gLFIASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR— Change of Contractor is to be signed and notarized by the property owner,
and t to 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 $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 2 - / \ rr^
Site Address: ! 51 (A)A
Original GC, subc [tractor or o er uilder
New GC, subc�actor
Reason for Cancellatior. 3`4 C eL
Permit Number -
License SLC License
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor/ u ontractor or cancel [ion of pe t . A permit cZt be cancelled if work has been performed.
SIGNATURE OF O 1ER (or wn /bt it er) e l URE GENERAL. CONTRACTOR (or new GC, as applicable)
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
follmin ent was ac wled ed bec reme this
dayof,20by
l
who is personal ly kno�e
or who has produced
m.
I i 1
Signatureof o ry
I
Date
aa$'•'�o, ANGELA M HUFF
Revised 04/15/ �'°•
• Notary Public - State of Florida
Commission # FF 234730
�•%„��h•
My Comm. Expires May 27. 2019
Bonded through National Notary Assn.
The following instrument was acknowledged before me this
_day of_ 20_ by
who is personally known to
me or who has produced as ID.
Signature of Notary Date