HomeMy WebLinkAboutCHANGE OF CONTRACTORa
PLANNING & DEVELOPMENT SERVICE
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE FEB 1 1 202,0
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-15�78 I ST. Lucie county, Permitting
SCANNED
BY
CHANGE OF CONTRACTOR SUBCONTRACTOR O'I'E.4 t11NGO)ISAMON OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
anthe 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: 0I71 aCaC Permit Number: S L C i 9 I) Q 37c?
Site Address: tt l f) U Lf,Vl
)� �� < State License�SLC License
Original GC, sulktractor or owner/builder
`K . -thm ps t'" 06C is State License f Q3003 Ob SLC License f� �?
New GC, sub ontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damag s an from any and all claims of action for any reason, which may arise as a result of this change of
con T r on for or cancellation of permit. A permit cannot be�cancell wo k has been performed.
SI A OF ER (or owner/builder) SIGNATURE G CONTRACTOR (or new GCS, as, applicable)
PRINT NAME PRINTNAME�C�I4 Ilit3W,Q, E I
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
AN day of —�D .20_!!e, by !�
lr_ who is personally known to me
CNL-
DEANNA MARIE GIVENS
MY COMMISSION # GG 022023
PIRES: Oecemher 16, 2020
d ru Notary Pu60c Underwriters
The following ins ent was acknowledged before me this
day of f (y 20�), by obE/4- ju"
��/who is personally Imo to
me or who as 5uced asIn / )
(����.-�-a, is fi/'z t Y
Signatut of Notary Date
$,µIp M1I Notary Publlo State of Plorida
Melissa L Butterfield
+� �0• My Commission GG 302065
qp. Expires 02114)2023