HomeMy WebLinkAboutCHANGE OF CONTRACTOR*.
PLANNING & DEVELOPMENT SERVIC-EkECEIVED
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
• MAR 3 0 2018
FORT PIERCE, FL 34982
SCANNED (772) 462-1553 FAX 462-1578Lucie County, Permitting
[ST.
BY
St. LudetftWotE 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 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:
3/212018
Site Address: 605 ptterman Road, Port St. Lucie, FL34981
errlltt Number,; i77 `
P.B. Brown, LLC State License CGC 1259288 SLC License
Original GC, subcontractor or owner/builder
Welsh Construction, LLC
New GC, subcontractor
License CGC.D41824 SLC License
Reason for Cancellation
The undemn* ed does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
costs, fee or ges arising from any and all claims of action for any reason, which may arise as a result of this change of
contract r/su n ctor or cancellation ofpemu[. A permit cannot be r c' d i[wor r has been performed.
SIGNATURE I dwNER
�-(or o1w,�na//builder) nr`' V SIGN TIIREGENERAL CO CfOR(ornew GC, as applicable)
PRINT NAME 1 a VVW� 1A) P `CAV, PRINTNAME KR WBISh
State ofFlarid% County of St Lucie County
The following instrument was selmowledged before me this
day of kafCAi .201&,
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3 2018
Slgn�ta fate
Revised 04/15/Oalrbne LeRnmeak
16 Notary ruuu,
sfato Or Nuw York
County of Oraane
Comrnt"lon KXPlraac 04/201"A
No. OI E6204353
state arFlortda, County of St. Lucie County
The following moo —met was acknowledged before To this
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/212018,
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