HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE MAR 12 2018
FORT PIERCE, FL 34982 permitting Department
(772) 462-1553 FAX 462-1MANNED St. Lucie County
SS 1'1'11f,..BQQY�� �,
CHANGE OF CONTRACTOR, SUBCONTRACTOR Oli�WETA' QN 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 signed by the general contractor only.
e new subcontractor must fill out a Subcontractor Agreement Form which is signed by both the contractor and
subcontractor. There is a $50.00 fee for the Change of Sub -Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: -7T 3 o'20 Permit Number: /%e) — D 3.-.-2_6
Site Address: t� a 1 L% A-vo' - t Fi— PAR CIE I ya�z,
A-;; L Tw e r_ State License'CCCdya /?.a,;�;LC License
Ori�j al GC, subcontractor or owner/builder
A—K R-�'«�- ��$C� �—tate License 04LC License
New GC, subcontractor or owner/builder T
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/ tt�contrac� ancellation of permit. A permit cannot be cancelled if work has been performed.
SIGMA F O or owner/builder) G GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME Cmrlus �4.l'1 0 PRINT NAME Ivn�Q
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
�t2- day of Ma►•c�
h .20by Lt_ Ca
(z�Ajn!l t 0 S who is personally known to me
or who bass; produced as ID.
Signature of Notary U Date
HILLARY HEPP
COMMISSION #FF149465
EXPIRES August 10. 2018
State of Florida, County of St Lucie County
The following instrument was acknowle ed before me this
�dayof MdYC l�--201ii by f0 y`J
%b who is personally ]mown to
me r o has m d - MD.
S' = 2LtMgt
;oiµn'c'"•..• TAWANDA PINKSTON-CA5TRO
Notary Public -State of Florida
Commission I GG 099917
;�� My Comm. Expires May 1. 2021
+�en�•"' Banded lh=u Nadoral Mtary rav-