HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave. RECEIVED
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578 APR 2 0 2017
CHANGE OF CONTRACTOR SGHNNEL,
Or Subcontractor or Cancellation of Permit BY
St. Lucie Counts,.
Change of Contractor is to be completed 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,
signature, and transfer fee. 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. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: y — � ck _
Site Address:
S.
Permit Number: SLC, 1ILoO6-03_4�0
IQfP_UGol C➢rl Q r Alyyl State License CC1C- (S 146�C License
Original General Contractor (or Subcon ctor)
"Yot Jqn State LicenseCZ 15104 3LLC License
New General Contractor (or Subgontractor)
Reason for Change Q,tr'2t ugyc -7,;N c�Q�Owl Uv\t _i0\,-_ 47cs Aca4t \C-
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 contractor/subcontractor or cancellation of
permit. A permit cannot be cancelled if work has been nerfnrm®
SWUNATURE OF R (or owTner/1builder) IGNATURE F/ NEB .1 GENE / C-�T'OrRp �1
PRINT NAME i «" 1 . kfJ lfd. PrA_. L Bo.D PRINT NANM Le j4 is /✓I l�' k V S-
State of Florida, County of St. Lucie County
State of Florida, County of St. Lucie County
The fo�1'ltoywing instrument was acknowledged before me this The following instrument was acknowledged before me this b r1 r, t
Say of II 20 IZ by 5'r2GG� day of rAii 20]�by.C.bLL 1-IKi1—�]!�
�— I
D Yl«yL who is personally to me who is personally know to me
or w Las produced as ID. or who has produced a.SLffJl1 +
Signature of Notary Date Signature of Notary Date
*Only signature required for change of subcontractor
Revised 07/21/14 e01V!W4..b AMYFELDMAN
* MY COMMISSION t FF 2206737° AUDREY B. HUMPHREY
..EXPIRES: April
`"+Jt�BOAdedfiNBu el NOh Btmn MEY XCPOIMRMESIS:SMIOaNrc4h F6F, 1270417972
�'%;<o�ho Bonded Thru Notary Public WMe�wGers
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PLANNING & DEVELOPAIENT SERVICES u 12016
BUQAING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 BY SCANNED
(772) 462-1553 FAX 462-1578 St. Lucie Co tt
CHANGE OF CONT O SUBCONTRACTOR OR CANCEL ON OF PE
PLEASE SELECT ONE OF THE EMDM a.
_> ,_CRA.NGE 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 OFSUBCONTRACTOR - Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT - The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: �� Permit Number: /b44, —d 37.K
SiteAddress: 9(,00 S.00eaY.��
Original CC, subcontractor
7
License64CPZ4i2-SI License
CEQ f ¢ 60Mn rW4;oA 126pApnftstate UcenseC.GC 151 QG2'j SLC License
New GC, AubcontractDr
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St
costs, feas or damages arising from any and all claims of action for any
con ctor/subcontractor or cancellation of permit. A, permit cannot b
SMOATUnOF (orowaedbuilder) SIGNAT
PRINT NAME S f —aa, Ja h.a,rJJ PRINr'.
Suteof Florida, C=aty of St Luoie Co arty
The Wmvimg insutmmont was aekwMedgedbefm me tins
Z2 day of A 2Dtb by §±a
Wi,Lr 'c wtwis knowvtome
or woo baspradw.ed as ID.
sigaahmO Notary )Mtn 7- 22-16-
Revised 04/15/16 �b AMMUM
s f MYC01911MONIFF?20679
EXPM$:APd14,2019
�+nan�� Bor247MiA�tNoNYSereMm
County, its officers, agents and employees from
o, which may arise as a result of this change of
e0ed if work has been performed.
State crEonda, Canary of St. Ltmie County
The following iasttumeat was aclmowladged bef mmethis
A'naay of i ,20LILby
kPs�-��who ispetsomny known, to
maea�wbohasprad¢ced aan).
9W IFJ2&.r 14
91geatamarNotsry D& 041ie,
RIKA RENEE FORSYTHE
MY COM0.11t331pN 8 PF295540
• $„ , EXPIRES May 28.2019
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