HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 NOV 15 Z018
(772) 462-1553 FAX 462-1578 BT. Lucie County, Permitting
�� SCANNED .
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GE'OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERNTf
St. Lucie Co�t'�N
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
i 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 permit.
Date: I S I Permit Number: '7 G 0 Z YS
Site Address: i I S YV d 1 A H l," V
_ •rr S�' Gv w5-J�ra c.} t`tr.. � L1, ti '
L I W /rl & art State License SLC License
Original GC, subcontractor or owner/builder
rC State License G bG iS gl 2ZLC License
New GC, subcontractor
Reason for Cancellation DL'rn\iC
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fror
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 . ncelled if work has been performed.
SIGNATURE O OWNER(or ownerfbuilder) SIG A CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINTNAME Jefa ii Gan!�/k h;A VL
State of Florida, County of St Lucie County
The following instrument was acknowledged me this
dayof 2011 Jkab- \/
SVla FOu kl who is personally known to me
or who has produced � jy1y_� r� l 1W11 as to
Lrbtni -
Signature of Notary : Date e —71 V
Revised 04/15/16 NEE
Sfate of ion GG N1M821
a.
State of Florida, County of St Lucie County
me
mart acknpv/ ledg�' jb,e,f��orem��e this
20_L
who is personally known to
e ✓ as ID.
Date
t,q A YENIA NOY-BAFiRIOS
sumo Notary Public. State of Florida
Commissiont7 GG 57808
My comm: expires Iles. 22.2020
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