HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPi r,NNING & DEVELOPMENT S�__VICES
BUILDING & ZONING DIVISIO
a
2300 VIRGINIA AVE [R—ECEIVEDIFORT PIERCE, FL 34982P 2 5 ��;g
(772) 462-1553 FAX 462-1578County, Perm
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLA$I NrQf�E
%;vnlvlMCU
By
PLEASE SELECT ONE OF THE FOLLOWING: St. Lucre bounty
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 ($71500 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 PERMT — 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: $I3e
Site Address:
Permit Number:SLC: I g O 8- 6 3�3
& t, - f, State License SLC License
Original GC, subcontractor or owner wilder
State License (UGC \52ot3$ SLCLicense
New GC, subcontractor
Reason for Cancellation exP`rJl
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 may arise as a result of this change of
contractt[toorr//�subcontract1/oorror cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (O�� owner/builder) S�T l RAL CO TRACTOR (�orJnm G'C,,u app&cable)
PRINT NAME � CtJISE e�Q„ PRINTNAME� I�ieS I-ICfiT IAASk
State of Florida, County of St. Lucie County
The following instrument was acknowledged before a5 methis
day of '�'+^' b'e 20 \ , by�2r1 -QPIIJA—
who is pers�wn to me
or who has produced as D.
loam� C1lzs1zal9
Signature of Notary UD,t,
R i 1Rrt((gqtt}}�r,y public Stets of Florida
R61yft G 131=
My Commission GG 2Y25S5
Expires o2m/2023
a
State of Florida, County of St. Lucie County
The fo(plowing ant acknowledged before me this
51 gay oft t�' ` 20-, by
A(, S C 1'aAjt :) who is personally known to
me or who has produced as ). / I
Signature of rt' taDate t
N®l@p�ry PuEIiC State of Fldrida
s �` MV �dFtia MlV®slur GG 214fi90
- t., o4,q; PAP ?MpfFE90g7®3f3D22