HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE SUAllNNED
FORT PIERCE, FL 34982 BY
(772) 462-1553 FAX 462-1578 St. LucieCounty
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
X 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 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: 9/18/2019 Permit Number: 1906-0637
Site Address: 2667 S Brocksmith Road, Fort Pierce, FL
State License SLC License
Original GC, subcontractor or owner/builder
Black Street Enterprises, LLC State License CGC1509119 SLC License 26256
New GC, subcontractor /I pp
Reason for Cancellation Lk"4 o�1i R.Q ICY
r
The undersignedAqbs hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or d ges arising from any and all claims of action for any reason, which may arise as a result of this change of
c ubc tractor or cancellation of permit. A permit cannot be cance c been performed.
S G TURE OF OWNER (or ownedbuilder) SIGNATU(/yJi GE CONTRACTOR (or new GC, as applicable)
P INT NAME Cedric Harmon PRINT ME L'onel J. Dunbar
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
18 day of September 201J by
Cedric Harmon wh 'personally knownt
Igna
as prod d as D.
9/18/2019
ium of Notary Date
"`"'" KRISYINA E DAVIS Revised 09/15/1 ;,+°• k:
' '- MY COMMISSION # FF960833
:awiy?�`� EXPIRES March O8. 2020
Ide]�398-0'S7 nmitlaNauyServ're.can:
The following instrument was acknowledged before me this
+a day of � 20by
Lionel J. Dunbar who' rsonally known to
Mae a has prodyrxd as m.
A F&CSL 9/18/2019
Si ate of Notary Date
f i"•'°"9t�;- KRISTINA E 2;':HIS
MY COMMISSION;, FF ir,'10833
EXPIRES March 06. 2020
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