HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT S.
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
MAR 3 0 2018
ST. Lucie County,
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 he 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 10tterman Road, Pon SL Lurie, FL 34981
�rmi�tunber• i
P.B. Brown, LLC State License CGCC1259288 SLC License
Original GC, subcontractor or owner/builder
Welsh Construction, LLC
New GC, subcontractor
Reason for Cancellation
License CGC 041824 SLC. License
The undersMub
es herby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
costs, fees es arising from any and all claims of action for any reason, which may arise as a result of this change of
connactorTs
cancellation,of permit. A permit cannot be egtgellyMIworloas been, performed.
SIGNATURE OF OWNER (or owner/bw7der)'� �,// SIGNMIRMNERAL CONTRAFTOR(or new GC. as applicable)
PRINT NAME .J� Y�o �J w"' PRINTNAME KR Welsh v
State of Florida, County of St. Iucie.County
The following instrument was acknowledged before me this
�`6.d
ayo ' 20�by
.JC, m e✓I -% -U;64 who is Personallylmown to me
r who has Pmd LI u..Jt os m.
31212018
Signature of Notary Date
porlono Lolbrcck
Revised 04/15/16 Natyry Public
State of Nuw York
Cooney or Groans
Commission
2 ir0s-04120162a
on E8
State of Florida, County ofSL Lucie County
The following Instrument was acknowledged before me this
__�_dayof 1 ,f&4' .201,0,by
R'4 Id-LSX whoisaersonallyknown to
me orAfio has ay
20118
7ID.
�—r
Signature of Notary Date
SONJA T. STARNES
NOTARY PUBLIC
STATE OF FLORIDA
Comm# FF156229
m�° Expires 12/27/2018