HomeMy WebLinkAboutCHANGE OF CONTRACTOR� I l,u - 00q5
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 SCANNED
(772) 462-1553 FAX 462-1578 BY
St. Lucie Countv
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 $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 6/6/2016
Site Address: 3100 N. AIA Fort Pierce FL 34949
Permit Number: kU01- WA6
J.Crompton Electric, Inc. State License CGG1504970 SLC License
Original GC, subcontractor or owner/builder
Tower Corn mu n ca�� i �RfJ� eP$ I/IC State License CGCIO�j PP SLC License
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 thi change of
c/9(ltractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work t
SIGNATURE R (or�ld ) sirN GENERAL CO CTOR (or new GC, as applicable)
PRINT NAME_ PRINTNAME -
State of Florida, County of St. Lucie County
The following � instrument was acknowledgedbefore me this
day Y3-'�S'�, 2dL, by
-49 �sa /' � who is personal) to me
or who has produced as ID.
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re of Notary Da e
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F
YIAN D. WASHBURN
Revised ommissbn#FF123287
xpires Mary' 14, 2018
delp„rtgfinkeubxe9dl4
State of Florida, County of St. Lucie County
instrument was ackn wledged before me tlys_
, (4,14 .20by K--
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' TAMMY l:. BAKER
Notary Public -State of Florida
-• ; ' My Comm. Expires Feb 12, 2017
Commission 8 EE 847470
Bonded Through National Notary Assn.