HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 St; Lucie County
(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. 1
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: ` 4 ab 1 g Permit Number: [�b� — 00_� 33
Site Address:
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S71las 9iSI lots State LicenseCWQ§-TI6:'SLC'License 03t A0
Original GC, subcontractor or owner/build
1 Ke/
_. V\1 l�d"c LLD , .J-i^L, . Statri License ` &�IS051�SLC License
New GC, subcontractor CGCk 561.5 Fq -
Reason for Cancellation
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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 ay azise as a result of this change of
mr for/subcontrac r �ncellation of permit. A permit cannot be cancellc ork has been performed.
SIGNATURE WNER (or ownerlbuilder) SI GENE1i1I. CONTRACTOR (or new GC, as applicable)
�A1��r� t' lC_
PRINT NAME 'GRr �-f(L Ni.0 41 P PRINTNAME I, �ce��vt A-f G/ t l y Ozj
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
'' day off 20_6— by
&Ifr .S aIZ2 /0, who is personally known to me
or who has produced -:a`��=.e-t� slag /g
Signature of Quiry Date
State of Florida, County of St Lucie County
The f llovag insbu ent was acknowledged before me this
_=day of 'r , 2012, by
//:c�' S E,4 YJh who is personally known to
me or who has produced as to.
Signature of NotaryDate 9 5 ad/
• TAMMY S GRASS
Revised 09/15/16 TAMMY S GRASS YY COMMISSION p FF969259
g '? i1fY COMMISSION a FF969259 „• EXPIRES March 06. 2020
EXPIRES March 08. 2020aeaarsa rion,r.nw,.. sen,:,y y,,,.
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