HomeMy WebLinkAboutCHANGE OF CONTRACTOR—R, PLANNING' & DEVELOPMENT SERVICES
BUIL,DINGI & ZONING DIVISION
2300 VIRG I U, AVE
FORT PIERCE; FL, 34982 ,
(772) 4162-1553 FAX 462 1578
C I' . GE, CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEAS vm1 ICT OF TBE EOL OwIlVG:
' I Cgi ,N FICONP+I CTOR— 0hange16f Contractor is ;to be signed and notarized by the property ovine
and the newt contraic r of record for the: cunent;pe rt I Ai new permit application' must also be'bompleted' with ne
contractor ksrmatll n and signature. Anew Notice bf Commencement -must be filed in the, new contractor's name
fort hob values greater man';$ 11500 ($7,500 if A/C Change -out). A recorded copy must be submitted `prior to
cc encmg a�nt1Y}lit
There Is a $50.00 fee for the Change of Contractor.
CZGE�SUBCONTRAdTOR —Subcontractor changes are to be completed by the general contractor.-
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The lnew s oll must 'filt out a Snbconlractor'Agreement Form. There is a $50.00 fee for the Change of Subl
Cootractorl 4 f
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CA�iCELION OF PERMIT Ttie cancellation of a permit is acceptable only if no'work has been don
I, I'i. Canbetlatloz� of pe Islto be signed aadn tacizedby'b'othtfie owner and qualifier of relord:'There.is no fee forn'cancella iol�ofthrmrt ,.I11
Da�e:; • 1 Permit Number:
I iteAddresslk�Qllld, 1C�brC12 F,-t ' (�iCfC"C— 1—I-- 3 LIME) j' 1
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I L State LicenseICRt-O5 3-1 � SLC License P 39 11
Orrgin'at G`C subcbil actor or o'wner/builder
Cu0 t ` Ili Q , 51 er' 'State License Ck CIt5 I"1157 SLC License
Newv, suiicontrac
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Reasldn for Ci + cellaio I ; •�
The undersigned does ereby agree to indemmfy and,hold hamdess St Lucie County, its officers, agents and. employees from all: `I
costs, fees orldamages (sing fromany and 'all cl s of action for any reason, which ay arise as a result of this change;of
I 1 11
contractor/su ntra�t or, hon I pernut �A permIit cannot be cancelled if r been performed.
SIG ry_TCIRE 6 qq owner/bud ``er) l - ' i t 1,81 IIGNIiTIJRE G c•l — `CC CTOR (or new GC,
as applicable)
PRZ T NAME -+I -..t ? l l May-) ..'h i - _ `PRINTNAI M r�C!O�' 3a mes Fta.� f
Smt of Florid I �ouutyl`f� Lucie6,im% I State of Florida,' County of St Lucie County +��
I The follbwing inI l t µs.- en flclm�o@wledgedbefore me this The following inst[umenfwds aclmowledged]7efore me this
(sI dayofl LDi 1120 nor '. by li Q\a-1n L15* day of 1 J 20 by SS�_ '
spersouallYTo ''. d
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1 b as pro uCed II I ,`AID eor who has prod ced as q ,
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SignlI to a of N iIsry; li� I Dfite �ignature of N.otary 'Date
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I yP `''` Notary Public Sta 7
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v ed 09 l Q' 'Y I a And berl of Flonda
State'�f F,odda 2a Lam
Ni traryPubl+d St�te of Flon L bet, i1 ����+ Commission GG'1 ,
m+an GG 1EM577 Poes 02%20/2022 �517
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