HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Faa462-1578
SCANNED
BY
St. Lucie Counts,
PLEASE SELECT ONE OF THE FOLLOWING-
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.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Sub -Contractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 1 I I c Permit Number:➢ -
Site Address: O l ®JU ) 11A,
G�c z- C`L1n � i'CS6ekk License License 1)s Li_Q
Original GC, subcontrac or or owner/builder {{yy, ,, .
State Licens cense
New GC, subcontractor
Reason for
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
agents, and employees from all costs, fees, or damages arising from any and all claims of action for
any reason, which may arise as a result of this change of contractor/subcontractor or cancellation of
permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINT NAME .1—S+'Ka-e� %
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
_day of 20 , by
or who has produced as ID.
Signature of Notary Date
State of Florida, County of St Lucie County
.The foldayofinstrument waz AQC acknowledged before C `P'��6
personally know to me
Notary
_.•p_µo�`R•WF10ftr• J /'
Commisol `StflSiot}�na
MY Comm. Er •,;R9 t$ ata Date
Revised 04/15/16
Apr29 16 08:47a Magda L Chavez -
! - ti
813 754-5161 p.2
Planning & Development Services
Building & Code Regulations Division SCANNED
2300T:rginia Ave
By
Fort Pierce, FL34982 `St. Lucie Co,,,,.
(772)462-1553 Fax 462-1578
PLEASE SELECT ONE OF THE FOLLOWING:
lCHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
antheew 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 $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Sub -Contractor Agreement Form. There is a S50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERH[T — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: �Y �j Permit Number:
Site Address: �l ��`{� r��/� `�
Y ,p e—AA- ` 1(�d `� JV%bateLicensen s%License QsLip
Original GC;, subcontra or or owner/builder
StateLicems��=i`=� ��cemse�W
New GC, subcontractor
The undersigned floes nereny agm w mckemnlry anti "ulu' n ltuea_ ot. Luutc wu .Y, a,a vuiwiu,
agents, employees from all costs, fees, or damages arising from any and all claims of action for
anf
on, which may arise as a result of this change of contractor/subcamactor or cancellation of
peA permit cannot be cancelled if work has been performed..
J ;
SIGNATURE OF OWNER (or ovmer/builda) SIGNATURE GENERALCOA'rRA1CTOR (oorrn(ew GC, es appbrable)
PRINT NAME 'k4 l 111 r1M C M I ( r I PRINT R-13�e
(DILL POGhdaIt
statedamida. CauatyafSls6Counly
The following iostumem was aclmowledgtd befam me this
_2Ldoyof Aprt I 20jiAbyW-114AIVI
7,
.,4,,,,• Bow
1$TIPI L dv.L:.,.s;a - idtArm
NOTARY PUELIC
)ALECOUNTY
DALE
OF GEORGIA
lWon EtmtrasAugust 16, 2019
SW of Florid• County ofSt Lucie Cmmty
eif�ol owing inmmnent s aek o leddaed�before�me this
'day of
,C who is pe mellylmow to me
IG