HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE SUAWWU
FORT PIERCE, FL 34982 Sq. Lucie Coun�v
(772)462-1553 FAX 462-1578
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
SiteAddress: 2667 S Brocksmith Road, Fort Pierce, FL
Original GC, subcontractor or owner/builder
Black Street Enterprises, LLC
New GC, subcontractor
Reason for
Permit Number: 1906-0638
License SLC License
License CGC1509119 SLC License 26256
The undersigned d es hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, f da ges arising from any and all claims of action for any reason, which may arise as a result of this change of
con to s c tractor or cancellation of permit. A permit cannot be cane 1 k has been performed.
SI RE OF OWNER (or owner/builder) SIGNA/TJ RE GEt RAL CONTRACTOR (or new GC, as applicable)
P NT NAME Cedric Hannon PRQ CNAME Lionel J. Dunbar
State of Florida, County of St. Lucie County
The following instrmment was acknowledged before me this
18 day of September 20 19 by
Cedd Harman who' rsonally known to me
o o as prod Fed
9/1812019
ign ure of Notary Date
Revised 04/15/16 KRISTINA E DAVIS
:�°
i•,
MY COMMISSION # FF960833
EXPIRES March 08, 2020
(407, 395-0'53 r1Wkk+N01a7SeMce.corn
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
to day of seot. 20, by
Lionel J. Dunbar who personally known to
me r has prorjyce as m.
9/18/2019
Ignat re of Notary Date
"'°•�¢� KRISTINA E DAVIS
- XMY COMMISSION # FF960833
0• ' c
'•;'uty,+•` EXPIRES March 08. 2020
W071 J95-0'SJ fbridalloc+ryService.car.