HomeMy WebLinkAboutCHANGE OF CONTRACTORSCANNED
St. Lucie BY
PLANNING & DEVELOPMENT SERVICES n
BUILDING & ZONING DIVISION SIEC�. � /77—D
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 JUN % 3 2016
(772) 462-1553 FAX 462-1578 PER[vfl TLJG
St. Lucie County, FL
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
X 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 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: 6/6/2016
Site Address: 3100 N. AIA Fort Pierce FL 34949
Permit Number:11001— 044r1
J.Crompton Electric, Inc. State License CGC1504970 SLC License
Original GCS, subcontractor _or, owner/builder
-rower Lp')1MU4tCc. (D1 �Qf�IcQ� � . State License CLC I S-09 I SPSLC Licenst
New GC, subcontractor
Reason for Cancellation l ottal( Comft % _ In�ofl t`�tr
The undersigned does hereby agree to indemnify and (Told harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and a0 claims of action for any reason, which may arise as a result of this change of
1I/contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work 1 ns beer pe t:
�rwo\I r.A
SIGNATURE OF OWNER (or owne�rlbu�ilder,) SIGNATUR •RAL CON R(or new GC, as applicable)
PRINT NAME 1 T VYr "1VLW.� PRINT NAME IA b�!✓ _
State of Florida, County of St. Lucie County Slate of Florida, County of St. Lucie County
day ofistrumet wae fallowing�s, ac owledged beforeme [his
20, by�
V who is personally kno tome
or who has pmdur d as ID.
gnature of Notary Date
Rev
"'M;,c DYLAN D. WASH9URN
='�"� =_ Commission# FF 123287
i� � a' Expires N1a 14,'
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before
to
TAMMY C. BAKER
�-�- Notary Public • State of Florida
: •5 My Comm. Expires Feb 12, 2017
Commission # EE 847470
Bonded Through National Notary Assn.