HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE SCANNED
FORT PIERCE, FL 34982 St. Luce G�,,,,t„
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
_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
`er
permit. /
Date: ` i � `Z / Permit Number:` 161(,19 — 00-237
Site Address: ^ (/ n�I dT,lgeF4� ��
1Z t �� D/{ ✓z-g State License �ri e �L� 0S! icense p'/ -1 S
Original GC, subcontractor or owner/builder !g!
�� ✓tt Oew (D.J r`l % x State License G' � `SLC License
New GC, subcontractor
Reason for Cancellation
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 performed.
SIGNATURE OF OOW1N'ERRt (oor,00wner/builder) SIGNATURE GENIME�R,A� LtONTRACTOR (or new GC, as applicable)
PRINT NAME! 1, .�i�� PRINT NAMECVA%- YVk YZ4AAJ IJa,
State of Florida, County of St. Lucie County
The
following instrument was acknowledged
�before
_me,this
d.2%yof 20// by (�./ L
l.:/LfL. who is personally knows to me
or o has produced as ID.
Signature of Notary Date
Revised 04/1 4a`Ar`i DEBORAH BOERCKEL
_.2�1' MYCOMMISSION #FF001318
EXPIRES April 12, 2017
1 ''n"•:�11@0tp FWWallotaryseMw.ccm
State of Florida, County of St Lucie County
following i�tmcut was acknowledg befo a to 's i
day of e7 hj.. . 20�, by
who is personally known to
me o vho as pro uce as
i afore of Nona biate
M wjk Notary Public Stet- of Flodde
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OF NU Expims 06121/2019