HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RE�ENEp
2300 VIRGINIA AVE JAN 14 ?019
FORT PIERCE, FL 34982 Permikin
(772) 462-1553 FAX 462-1578 �t' A U W Capart
oun,!nerlt
BY
St. Lucie County
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEAS ELECT 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: aQ /,X / d d /i
Permit Number: L 1A - bgj
Site Address: � ,6 A)' ,41A Fl • AatC FL,
State License SLC License
Original G� subcontractor or owner/builder
bu �� h'DiL4 L�-' State License SLC License
New GC, slabcontraGtor
(21
eason for
i 4(3 ' i oA%_ /.t)d
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
costs, fees or damages arising from any and all claims of adtion for any reason, which may arise as a result of this change of
contractor/subcontractor or t lation of permit. A permit cannot be cancelled if work has been performed.
/ OFOF Ow'f '
NAT[7RE OWt1112 (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME Z O d ( (AJ A ' /19Jfa t PRINTNAME
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this �� ��®
day of JM,13 .20A by�QS FIISJGtt.
who is personally known to me
or who has produced MN DL— as iD.
,1. e ///9'//9
Signature of No Date
Lr ."' ELLEN VAUGHN
so �.
Revised on/ 6 ks State of Florida -Notary Public
=• •= Commission # GG 270079
My Commission Expires
October 22, 2022
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of 20_, by
who is personally known to
me or who has produced as ID.
Signature of Notary Date