HomeMy WebLinkAboutCHANGE OF CONTRACTORM
.l
0
0
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE, FL 34982 JAN 16 2020
(772)462-1553 FAX 462-1578
ST. Lucie County, Permitting
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
SCANNED
PLEASE SELECT ONE OF THE FOLLOWING: BY
CHANGE OF CONTRACTOR - Change of Contractor is to be signed and notarized.tw4ffi$!i 1�ii tr,
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.
ACHANGE OF SUBCONTRACTOR - Subcontractor changes are to be completed by the general contractor.
nee 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: f 1 l o Zc�l Permit Number: l `1 b `1 — b l l&
Site Address: 3 (O �1 w w w p,! PPA_ `0 C. t Cl AFL-
SR_/Prp-"c State License SLC License 133 I (O
Original GC, subcontractor or owner/builder
j Zoo F 'gyp C, p t2 s L� C� State License SLC License 23 0 3 g
New GC, subcontractor
Reason for Cancellation IJN St70NS\cJE OQ-k(5 NN L S�6CoeTj�AUb��
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
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
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/buflder) SIGN RAL CONTRACTOR (or new GC, as applicable)
PRINT
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
by
personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
PRINTNAME rZ_95` Ss/ A P& 1
State of Florida, County of St Lucie County
Th_ e�fplllowing i ent was Z� le ged before me this
to
Date
KAREN S. NIELSEN
State of Florida -Notary Public
.; commission # GG 207484
My CommissionExpires
June 12, 0