HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE ✓_gl,Fo
FORT PIERCE, FL 34982 p qNl�
(772) 462-1553 FAX 462-1578 ?p
BY
PLEASE SELECT ONE OF THE FOLLOWING: St. Lucie County
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 sighed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date:
Site Address: 2 L9 3N CW I Evc a '
Permit Number: I q D'1 - 05U 3
t=AcCy (Q C)Dnrktc+t on State License SLC License 21OSS
Original GC, subcontractor orroownedbuildcr
Ac NuCLWJ f kC—+n b State License SLC License Li 120
New GC, subcontractor
Reason for Cancellation m t(� t m)y r— I ng nr2 r f 7 —&f e7 Ho _Q
The undersignel does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
costs, fees or da ages arising from any and all claims of action for any reason, t,Ihich may arise as a result of this change of
contractorisubcopiwor or cancellation of permit. A permit cannot be cancelled if work has been performed.
PRINT NAME
State of Florida. County of St. Lucie County
The following instrument was acknowledged before me this
l rday ofs�{ 20?D,by Ii6119
dir mbo is penomlly known to me
or who has produced as
Signature of Notary Date
Rev±sed 04/151t N `j,
��� Comm.fGG9249 0
a'0 % Bonded Thu Aam No* H
Stain of Floridd'County of St. Lucie County
lowing in tnrmcnt was acn�ledged before. a this
day20, by�q
-iCPdk
I/� who is personallyknown to
me or who has produced as as lD.
A
Signature of Notary Date
C qng
RM.m2Z�
ThrUA8=NoWy
9StLuciel St. Lucie County
2300 Virginia Avenur
Fort Pierce, FL 34982
Date Invoice Reference
---------- ------------------ --------------------
09002 GRBK GHO Homes, L.L.C.
01/09/20 MN-67 Sub Change 090120,0067
1j Remittance
9StLuciel St. Lucie County
2300 Virginia Avenur
Fort Pierce, FL 34982
GRBK GHO Homes, L.L.C.
09002
09.02-00011564
Jan 10, 2020 $50.00
Seacoast National Bank
0670051584487129890
Payment Amt Retention Discount Total Payment
------------------------------------------------------ ----------------
50.00 0.00 0.00 50.00
---------------- ------------- ------------- ----------------
50.00 0.00 .00 50.00
GRBK GHO Homes, L.L.C.
Check Number 09.02-00011564
Check Date Jan 10, 2020
Date- Invoice Reference Payment Amt Retention Discount Total Payment
---------- ----------------------------------------------------------------------------------- ------------- ----------------
09002 GRBK GHO Homes, L.L.C.
01/09/20 MN-67 Sub Change 090120,0067 50.00 0.00 0.00 50.00
----------------------------- ------------- ----------------
Total Remittance 50.00 0.00 .00 50.00
,Z) TM