HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RecejvEO
2300 VIRGINIA AVE J11N 2 6 `10ig
FORT PIERCE, FL 34982 SCANNED Perngtung p
(772) 462-1553 FAX 462-1578 By St tuc)e Co amen:
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: 5-,hn h $
Permit Number: 1712-0535
Site Address: S350 S+e-eI 2 1 �d F4 . Al_ �u 3 y 1g6p
Michael E Jacquin/ Paul Jacquin and Sons
License SLC License
Original GC, subcontractor or owneribuilder
Summacor LLC Z7
State License SLC License
New GC, subcontractor
Reason for Cancellation
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
contr C o /s bcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
b4O � i.
SIGN •OFOWNER(orowner/builder) SIGNATURE NERALCONTRACTO (or new GC,n plicable)
PRINT NAME Laura Sharp for Tattoo Yachts LLC PRINT NAME
&Ntbrntn.a.A Arun -e-0A
State oifimid a, County of State of Florida, County of St. Lucie County
Me f lowing instrument was acknowledged before me this
_dayof b LAtAr& Sh&f?
who is p so.ally known to me
or who asp odneed tA1 ID. t("IS�
-. t_& --W 1•$
Signature of Notary de
Revised 04/15/16 W NATAUEASIK
COMMISSION n18M
NOTARY PuBIJC• CAt1FOFM
�r GEEa COON b 11, 4021
The following instrument was acknow edged before me this
f day of, .'�'Tfy.Q .tt2�yI by
tAA/ ' 1s personally known to
me or ,w/ho has produced__Z)(_�_as to.
Signature of Notary Date
HEATHER BURFORD
State of Florida-N;10otary Public
?. a Commission W GG 183217
MYFabruary 06, 022res