HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
SCANNED
BY
St. Lucie County
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
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 Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMTP — 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: I [19 I Z01 (o Permit Number: 1(a Oa. - 01 S 3
Site Address:%043 S. US NWY-1,5VITt Z03 1301r-+ St L-Ucie IFl— 3k10tS0)--
I YNAMIC AM QUALry(aC00Ltri&S4s. State License SLC License
Original GC, subcontractor or owner/builder
_A 1 R P N b H {i AT S Y S 1 E M S Ll_ �L State License C A C 161 S34 (0 SLC License
New GC, subcontractor
Reason for Cancellation FA I u ¢ E '16 PC-- R Fo e M
The undersigned does hereby agree to indemnify and hold harmless St
costs, fees or damages ari ' any and all claims of action for any
con actor/subcontractor r c cell lion of permit. A permit cannot I�t
;S&NA�OFOWNM (or own wilder) S16NATI
PRINT NAME u AA S /L/14JO /G/PE PRINT]
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
lyxdayof TOLY .20_ Eby
Gfoksrlrn 0 Elr.! who is Rtg2yly known to me
or��yyo has produced as ID.
717vh014
Signature of Notary - Date
t.B 1ENDAAILEENALYAlIEZ
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R r . e AW Y6COMMISSION #FF032640 .
EXPIRES September 76, 2017
(407)398-0153 FloridallotaryService.com
its officers, agenA and employees from all
may se as a r It of this change of
vork hts been o formed.
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State of Florida, County of SL Lucie County
1'he fp]1(owing' w eat was aclglpwledged before me this
�' `",,Lta`yr�of MR .2 0�, by—
.lP FWAl n who snersR onallvkhown to
Signature of Notary
�oSTINA P. STAMPER
_ , ` o'1, Notary Public - State of Florida
• ' e My Comm. Expires Jan 8, 2017
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'o Commission # EE $36196
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