HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMEN it SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
OCANNED
BY
i-"(-ie County
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERNIT
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: 8-13-16
Permit Number: 1604-0149
Site Address: 3051 industrial 25 Street Ft. Pierce, FL. 34946
JAH Construction LLC State License SLC License 29694
Original GC, subcontractor or owner/builder
Paid lacquin & Sons, Inc. State License CGC 060473 SLC License
New GC, subcontractor
Reason for
to local General Contractor
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 re so w , arise as a result of this change of
color atar/subs actor or cancellation of permit. A permit cannot be cane if ork has been performed.
SIGN O p W� NER (or owner/builder) SIGNA O RACTOR (or new GC, as applicable)
P IN MEN/ _b+"IXr �7, pRiNTNAME MI ae1jacguin President
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
lU dayof A.v.,rn.lr 20 6,by �rJM+Llt
Cfuz- who is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 09/15/16 "':`"o � LISSETE MORALES
Commission 9 FF 985823
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The following insinunent was acknowledged before me this
day of U UST , 20fta_. by &L cHAkL SK4na-J
who is pg mown to
me Ge produced as ID.
as ID.
'n at Notary Date
�,Olffl ftQ4� Notary Public State of Flodda
Gregory S IUaIHn
y, My Commission FF 232514
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