HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services SCANNED
Building & Code Regulations Division St. Luce Countv
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax462-1578
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 $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERbHT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: a3 )'n�i— e20110
Permit Number:
Site Address: �26d_ `s-✓'n4,d1 ()4k 1a✓-e—
License SLC License
Original GC, subcontractor or owner/builder
7or,% PA0-or4 Sim Prg, State License C713L 1?2582 51SLCLicense
New GC, subcontractor
the undersigned does hereby agree to indemnity and hold harmless St. Lucie County, its otticers,
agents, and employees from all costs, fees, or damages arising from any and all claims of action for
any reason, wl 'ch may arise as a result of this change of contractor/subcontractor or cancellation of
permit. A per it cann cancelled if work has been per u d.
SIGNATU GF NER(orowner/btiilder)- -- - --- RALCO TRACTGR(ornevGGasapplicahle) _—
PRINT NAME[4Y1 ,OLD MELVIt.(_(_ PRINT MP � •2ri� /" /
State of Florida, County of St. Lucie County
The following instrument was admowledgedbefore me this
' aoday of KAi . 20$, by_AAP_Q�
IylGL�lll,1 who is personally know to me
of Notary
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State of Florida, County ofSt. Lucie County
The following instrument was aclmowledd&ed before me this
oZ-5- day of a 20 by)G1it2J
V �tV°" Notary Pudic State of Florida
Patricia J Yount
Revised 04/15/16 �,• My Commission EE 854831
wrs Expires 11/2972016
know to me