HomeMy WebLinkAboutCHANGE OF CONTRACTORYju.xNNING & DEVELOPMENT a >RVICES
BUILDING & ZONING DIVISION f
2300 VIRGINIA AVE I
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 ��
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
H NEL7
BY
PLEASIrSELECT ONE OF THE FOLLOWING: St. Lucie COI1 b
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.
'NBS- 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: 7n8116 Permit Number:
Site Address: 10867 S Ocean Or, Jensen Beach, FL 34950
1606-0212
CO UNTC'—I 0
LL � State License CCC d S�f 8' ySLC License
Original GC, subcontractor or ownerlbuilder /
Code Red Roofers, Inc. State License CCCI326574 SLC License
New GC, subcontractor
Reason for Cancellation
G4" CO S�
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 this change of
contr or/subcot cancellation of permit. A permit cannot be celled if work has been performed.
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GNATURE OF OWNER (or owner/builder)SI ATURE G CONTRACTOR (or new GC, as applicable)
PRINT NAMEV' C)60-T"tLPRINTNAME S E e—
State of Florida, County of St. Lucie County
The following instnunent was acknowledged
(before methis
k_day of ti 20�, by �`C �
&5 )-Awho is personally known to me
or who has produced as ID.
Si a re of Notary ate
PERRYC.CAUGIURI
!r+ � MY COMMISSION P SP OS9022
Revised 04/15/16 EXPIRES: Mamh6,20I6
aar4od ThN NotaryPuck Uadd mMfs
State of Florida, County of St. Lucie County
following ins me t was aclmy}�'fed before me this
��JJday��of 20A9 by� j a
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