HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT StRACES
M, BUILDING St ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE FL34982
VIYED
(772) 462-1553 r FAX 462-1578 '�HiBY
St I-UCip County
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELEC'r•ONE OF THE FOLLOWING:
_CHANGE OF CONTRACTOR —Change of Contractor is to be signed and notarized by the propertyy owner,
and themew contractor of record for the current permit. A mew 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 -wort:. There is a S50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR - Subcontractor changes are to be completed by the general cotiwcton.
The new subcontractor must fill out a -Subcontractor Agreement Forte: There is a•S50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PE1011T- The cancellation of a permitis acceptable only ifno woik 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: August 29. 2016 Permit Number: 1605-0484
Site Address: LIMC) M, AI -A •ikff� i?ieY-Lo t FL 'M(W j
Muyan Restoration Waterproofing 8 painting Service LLc State License CGC 1523253 SLC License
Original GC, subcontractor or owner/builder '
-Concrete Restoration Services by Danletio &Associates Inc State License CGC:1518181 SLC License
New GC, subcontractor
Reason
The and timed does emby agree to indemnify and hold harmless St Lucie County, its olficers, agents and employees
costs, f or damag arising from any and all claims of action for any reason, which may arise asa result ofthis change
con An con for or cane (ation of permil. A permit cannot a if Bork has been performed.
SIGNATURE Of OWNER (or owsnrlhuikIcr) S:GNAT� LLLCCOa.N'TRALTOR(m.,,GC,.Mp lhle)
P,iIfi-T NA`T ttLUVV h, ^'Rk- PRINT.�'ANE 'I t1T �s C\� 1—
P2Es�as1>
Stuc of rorid;t County ofSL Ludc Counq'
"Me a lowing i., umenl e'n eckntxiedged he rc me this
P—Ab4• sdm is pcnondly knosm to me
orxPiled an 11).
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Signature of Nonry Uate
Revised 04/15/16
E.Q.
HATHAN M LODISNotary Publla - State of Florida
r Commission • FF 031338
>; My Comm. Expires Oct 27, 2019
Sue of rondo, County of St Lucie County
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FISHNA
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November
EXPIRES: November 5, 2018
EXPIRES:
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