HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES BUILDING &
ZONING musiON 2300 VIRGINIA AVE FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLE E SELECT ONE OF THE FOLLOWING: BY
x St. Lucie County
`—� CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property
owner, d 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 jobvalues'greaterthan $2,'500•($7,500 if A/C Chdiikeout):'A'reedided copy mustbe'submitted pii& 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 SubContractor.
- 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: f v I + t 3 . 20 t Permit Number: 7�a• (%� �
Site Address: 7 /� � � ` f
1,�.� o j 5or<ft, US }-lr �'1�._ �c',� (`
State License SLC License q5 17
Original GC, subcontractor or owner/builder
= &W- 0 01 Mate License SLC License__`
1OA GC, subcontractor
ReasonforCancellation /f,�„�•, /j, .4 r7l),
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 C ell work has been performed.
SIGNATURE. OF OWNER (or /,� l ---
PRINT NAME
State of Florida, County of St. Lucie County
The following cat was ackno
wledged Mon: me this
day f .Z0 by
S who is ostsnaslly�anvmw
me or who has prod»d . tSM
>' •• I cwro�P,kays
u .< MY MIFF148aW
EXPIRES: November 26,2ola'
A 1 • 8&dWremNdnyF,,* Unmmho
Revised
new GC, as
PRWTNAME -7fjwLv� 4 e--4167T
State of Florida, County of SL Lucie County
The follo�mb insnum was aclmow %gW before
methts / / Awn O�by
��s���
known to a orwho has produced
SiVwtme of Notary Date
EO=Mj
EYg HlR,1PHREYMISSIQVpFF l74772S: March 6, 2019 Notary Public Undeiwitea
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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.
X 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: July 20, 2018
Site Address: X 6 Z0 I
Nathan Cooke, Cooke Construction, Inc
Original GC, subcontractor or ownerlbuilder
New GC, subcontractor
Reason for Cancellation See Attached
Permit Number: 1712-0105
License CGC1520585 SLC License
License SLC License
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or contra sages arising andall claimstof ermtion fort b reason, p suit coed. change of
contractor/subcontractor or a Ion of ermit. A permit cannot be cancelled if as en performed.
sidKATuRE OF owNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME ,,677WA/(�l�Pr PRINT NAME /�'/%T�6 C�f-c
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
day of :50ky 201 B by N v\
Co DkL&_� who is personally known to me
or wh u as ID.
i� i July 20.2018
Signature of Notary Dale
WALTER 0 PAYNE II
Revised 09/15/ °+° F'{ Notary Public -State of Florida
Commission M GG 24467
Noe My Comm. Expires Aug 2572020
Bonded through National Notary Assn.
State of Florida, County of St Lucie County
The Ilowing insucupi t was ackn edg ofgrg me this
/_day of l 20 1 by `9'to-h
who is personall (mown t ✓
mef Ice as ID.
Cd.1 July 20, 2018
Signature of Notary Date
Notary Date
aWALTER 0 PAYNE II
irllu
Notary Putilic -State of Florida
°•Commission N GG 24467
= My Comm. Expires Aug H.;.2020
"BondeO througtl National Notary Assn.