HomeMy WebLinkAboutCHANGE OF CONTRACTOR-
PLANNING & DEVELOPMENT SERVICE
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL.34982 MAR 3 0 2018
(772) 462-1553 FAX 462-1578 5T. Lucie county,
ty,
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
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: 3/2/2018
Site Address: 605 Kitterman Road, Port St. Lucie, FL 34981
P M—dt urn elf: '
P.B. Brown, LLC State License CGC 1259288 SLC License
Original. GC, subcontractor or owner/builder
Welsh Construction, LLC Slate License-CGC 041824 SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold hamiless St Lucie County, its officers, agents and employees. lion
costs, fees ges.arising from any and all claims'of action for any reason, which may arise as a result of this change of
con tractoATURr/ ubc for or cancellation of permit. A permit cannot be c to has been performed.
SIGNATURE OF (or owner/builder) 1 SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME qa VVW" �/ n PRINTNAME KR Welsh
13
Stale of Florida, County of St. Lucie County
State of Florida. County of St. tilde County
The following instrument was acknowledged before me Us The following instrument was acknowledged before me this
B dayof 20�Lby— 1 day of 94 A" It .20LI&—by
Q. 1 wbo is pmonallyknown to me 1,t 12-LJ'Z(5 �s who is persarelly mown to
i-arwho has produttdL.� as ID. o� o hasp u y as ID.
^.7\U�i^W- ((1 3/212018 1 „� ,c,c,..i., 312f2018
Slgnatmvo a Date signal ture of Notary Date
SONIAT.STARNES
NOTARY PUBLIC
Revised 04/15/16 banana Lalbrook -.STATE OF FLORIDA
Notary Public Commo FF156229
Stalin of prow York
Coen co,stirity r n or am,,, 1 Mo ova Expires 1212712018
Expire.: o,rzoy,Z pal
No. OIES204363