HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SEi v'xCES
BUILDING & ZONING DIVISION
° 2300 VIRGINIA AVE J`'BY ED
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 UCiP. COun
tv
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT•ONF._OF THE POI:LOW NCB ,
_CHANGE OF CONTRACTOR —Change of Contractor is to be signed and notarized by the property owner,
and the new contractor ofsecord 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 time
for job values greater than $2,500 (S77500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There is a S50.00 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•S50.00 fee for the Change of Sub -
Contractor.
_CANCELLATION OF PERYHT — The cancellation of a permit is acceptable only, if no work, has been done.
Cancelfation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fie for
cancellation of the permit.
Date: August28.2016 Permit Number: 1505-0391
'5iteAddre-ss: 4\60 NAJIA EDO ?iefce EL. 3A)4',
Muyan Restoration Waterproofing 8 painting Service LLc State License CGC 1523253 SLC License
Original GC, subcontractor or ownedbuilder
Concrete Restoratlon Services by Danielle 9 Associates Inc State License CGC 1518181 SLC License
New GC, subcontractor
Reason for Cancellation -C9r 71((L'yj +"• �a �-'t>i
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, for damag • arising from any and all claims of action for my reason, which may arise 05 a mull of this change of
Conn",e lsubcont for or c cellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATUItEOF1.(WTER{oruwnerlb�uir)
sIG\ATUREISLCOIPCRACI'OR{oracwGC, as appl�bieJ,,t�
PRINT NAMl*e6ZF k, W`/kPIDi%
PRXI`NAM'E�r¢J d' =(. SQ\P1 V`.. .
YnEs1Stl�,s
Etac at FloriJi County orSt. Lucie County
smtc aeFloda3 caw,ry urstLad, Caimty
The fullowing in int cot xus acl..'I, J'cd It ff at this
day of orb>'�IY
The 611owmg iaswmrnt wit acLnmAuJnvl bcfae me the
C da:' 0 0y 1 20A 1(a,
.20
fNLNtr nfro is persoway Lnoxn mmc
xfia is brolly - rota
orx prgd� _ Gat /�fb
otcMwh cW. LED
sigutu"ANotary Dam
57goat
UIUN
4R ;; MYCOMMISSION4FF172013
EXPIRES: November5,01e
Revised 04/15/16
. - -
W. r
•.��f�,., Bonded TNU NetWWdkUMemBara
NATNAN M LODISE
_ s Notary Public - Stan of Florida
—
— ? . Coannies m 0 FF:93133t1
My Comm. Ezpiret Oct 27.2019
—
R. .