HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOI
BUILDING & ZONING D
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX
JUL 3 2019
Permitting Department
St. Lucie County, FL
LEAS ELECT ONE OF THE FOLLOWING: BY
St. Lucie Gou�
CHANGE OF CONTRACTOR— Change of Contractor is to be signed an notanze b 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 PERNIIT — 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: jl 1 / 1 9 Permit Number: I M5 - C�) 319
Site Address: 52 3 q ChWomd LGicEb ice-, E4 B ecc-e , EL- 3 ` 9 )
R8ciO-_Ckf2edlC\NAJ?(—V, State LicenseCRCOrjIWISLCLicense PM II
Original GC, subcontractor or owner/builder
SGo-F'i"'mai ots +alDer State LicenseSC1511157 SLC License �S k D 4 S
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fror
costs, fees or damages arising from any and all claims of action for any reason, which ay arise as a result of this change of
conhactor/su e?ntmctorr cy meeliation of permit. A permit cannot be cancelled if r been performed.
SI ATUREOF I/ ER orowner/builder) SIGNATURE CO CTOR(or new GC, as applicable)
PRINT NAME i<e,lk Torn1lnsoh PRINTNALs 3c, .T 1 Fbiber
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
isr day c(_�, 20 nn s .by -C'.\ On
't1 j YlS t7y-1 who is ersonelly b to me
whohasproduc oll).
Signature of Notary Dat'c
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Revised /15u(,L Nom,y pub11c S1ete of Florida
Andrea Lambert
My Commission GG 1 e4517
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State of Florida, County of St Lucie County
The following instrument was aclnowledgeeefore ethi
{ sF day of '-T QT 204 by SS .
bec who spersonallYlmo 0
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Signature of Notary Date
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Notary Public State of Florida
Andrea Lambert
My Commission GG 154517
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Expires 02/20F2022