HomeMy WebLinkAboutCHANGE OF SUB CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 SCANNED
(772) 462-1553 FAX 462-1578 BY
St. Lucie County
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
comm rang 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: I0 —30 — 20/ 7 Permit Number:/ %% a o `ice
Site Address: Z103 SatTl4"G9kxh fL !/C.� 11.t!A5 A!'�- YN' JLT �/NZ=rd"Z
/11 ✓L?2c5!! % axa1e-7t�e State License SLC License
Original GC, subcontractor or owner/builder
5 et�rF t c Tnf c State License TC 4 SLC License I O
New GC, subcontractor
Reason for Cancellation .ZYtNESS a:24' OcA4✓62 aPA?11 C&,∾6- 'Fl
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 OWNER (or owner./builder) SIGNA R GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINTNAME
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this l� following instrument was acknowledged before me this
_day of , 20by ` IL day ofC�r k 20J_-J by
is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
who is personally known to
m �d-has produced as ID.
i I111)'1
igna ore of Notary Date
,.1 .rya, LASHAHNAINt�"
+°. «`? Notary Public • State
of Florida
N� p My Comm. Expires Dec 20, 2018
°c° Commission V FF 177249
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Bonded through National Notary Assn.