HomeMy WebLinkAboutCHANGE OF CONTRACTOR - SUBCONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION F RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 SEP 2 8 2019
(772) 462-1553 FAX 462-1578 1 ST. Lucie County, Permitting
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
SCANNED
PLEASE SELECT ONE OF THE FOLLOWING: raBY
_CHANGE OF CONTRACTOR — Change of Contractorus R 13990 l 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. I g O q /0S& q
//
Date: `l xD Permit Number: O /
Site Address:
2i)
(n f-i7 L)P On t, Co-k S-f r�o G ,'&\ ` State License SLC License
Original
nGC, subcontractor or ownerlbuiilder
q�pt/t. N�I4 �j i�/1� 7)ky lP7rD' State LicenseaC D M SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St 1
costs, fees or damages arising from any and all claims of action for any
contractor ubcontract a of permit. A permit cannot
FOWA-nO7e
PR E ZeIklPRINT
State of Florida, County f St Lucie County
The following i was ac1on ledg befo a me thi
day o 20 l� byS� bED
q wris personally known to me
or who has urodu&A f'fn L JGr !u ID.
, agents and employees from all
as a result of this change of
new
State of Florida, County of St. Lucie County
The following t nt was ac wled ?�o�ree is -I� ; ..O
day of mtm , 20�, bye Yf3SJL�If'tU1 0 e.?_
wtA is personally known to
me or who 9s p?kducedtJ= L as ID.
KAREN S. NIELSEN
�•°`ens; 4-im
,,, KAREN S. NIELSEN >�° State of Florida-NotaryPubli
s_State of Florida -Notary Publ=• Commission # GG 207484
Revised 04/1 •= Commission# GG 207484 "a�, «, Pc` My Commission Expires
P� My Commission Expires ""� "� June 12. 2022
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION _
2300 VIRGINIA AVE RECEIV5D
FORT PIERCE, FL 34982 SEP 2 6 2019
(772) 462-1553 FAX 462-1578
ST. Lucie County, Permitting
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
ANNED
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
Comm ncing 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. 19 0(/) Date: C1 I a'� Permit Number: /.JK,L---B'�oT6
Site Address: / 910 h2i-MOV7, (A_ ( , PA l 1` d
S? 1'C902 C9 I L COA S41 Ud i 0A ` State License SLC License o-1
1O-riginal GC, subcontractor or_Iowner/builder
A�JVC a�/1Gf �t AA neVJOf�.IkState Licensed ( W6 SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its office , agen� and employees from all
costs, fees or damages arising from an
s of action for any re n, which may Ise as a sult of 's change of
contrac orlsubcontractora LEI anon of pe '
. A permit cannot N ncelled if Z, has d.
4
SIGNA NER� oe
SATRE GENERLCOCTOR(orappl�icable)
j
R}'tca
RAME U
o.
PRINT NAME fW`'Q
State of Florida, County of St Lucie County
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
a ollowing i was ac ledg efor e
=,day o�, 20( by�f R �fj(�Y7�(c-lv
_day of 20_� by
who is personally knmm to me wh Tsi personally known to
or who has produced as ID.
me or who as pro uc Fi as ID.
Signature of Notary Date
i ature NQo�e KAFfLN S. NIELSEN
i� State of Florida -Notary Public
= _ Commission # GG 207484
Revised 04/15/16
%?�. oa My Commission Expires
���n°n`�r"'
June 12. 2022