HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPLANNING & DEVELOPMENT SERVNEAveD
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE JAN J� 2020
FORT PIERCE, FL 34982 permitting Departmen' SCANNED
(772) 462-1553 FAX 462-1578 St. Lucie C",`BY
St. Lucie Counh
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT 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.
X 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: I Ili 12020
Permit Number: «W -()Z2,1A
Site Address: ;!-,U Qy -& \U ( C-1-A (t-
EI-eC31i C Wan-C_CA- o State License SLC License 2I O S S
Original GC, subcontractor or owner/builder
G\ iAA 1SA t tX C.7VYl C State License SLC LicenseEC13W q I2cb
New GC, subcontractor
Reason for Cancellation
costs, fees or
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hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees Cron
arising front any and all claims of action for any reason, hich may arise as a result of this change of
)r or cancellation of permit. A permit cannot be cancellep if work has been performed.
State of Florida. County of St. Lucie County
ICY
The following ipswment was aclou "fledged before
� me this
dayof. lGY1tAQYy20 A/, b.__-m
nitg.is.person illy known to me
or who has produced ' as
.>4 - � i 19 bww
Signature of Notary Date
CONTRACTOR (or new GC, as applicable)
d I I I iLI M H(_A hcl.l-e V
State of FloridCCounty of St. Lucie County
e following instrument was aclau vlodged before a this
aay-1of _ 1' G/vt 1A, n� 20—Eby IN t I I Ili I r)
40 nd l C.Y who is pc�ny lmam to
me or who has produced as ID.
,,A,- (IgIcaw
Signature of Notary U Date
Rev_sed 04/15/16 A....... C. Vell..yy
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