HomeMy WebLinkAboutCHANGE OF SUB-CONTRACTOR AGREEMENT•u "" r , PLANNING & DEVELOPMENT SERVICES
BUILDING &ZONING DIVISION
2300 VIRGINIA AVE �jURo 4,oq����
FORT PIERCE, FL 34982 a,j
(772) 462-1553 FAX 462-1578 Ai Sr.,, ,
aXE[VED
ApR 11 pJQQJJ�% CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
Tunent
l ��®t�LEASE 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
commegcing any work. There is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subconl ractor 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 Suh-
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: `i/�/ %2S PermitNumber:
Site Address:
,hate License SLC License
Original GC, subcontractor or owner/builder
CO �leaL//e- CP itateLicense✓S&LCLicense
6�
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and ]told 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 ma rise as a result of this change of
contr or/subcontractor or cane la[ion of permit. A permit t annot e c celledZifchas been performed.
yz - �Lt.
A FOWNE (orownerlbulder) - SI NATUk GEE ALCON7C QR(orncw GC,asapplicable)
P NAME��� PRINT NAME
State of Florida, County of St. Lucie County
this
l71 ( LN Ic —who is personally knmvn to me
j
ohasproduced �l�as ID.w �= i A
ture of Notary Date
Revised 04/15/16 ae hdo Btownsteio
It.NOTARYPU9up
STATE OF FLORIDA
Cwmg FF223EW
ExpU*o 4/2M19
State of Florida, County of SI. Lucic County
Th• ollowmgins m�enl�was ack�noowicut; ¢rcipr m�IniIt .N
11 day of tT1f)J.0 L;20-W, by _.._ll_., �V .
'U who is personally knorm to
me ornvl o.ha Produced 1'�as P. /
ary Date
;4ppY Poo�o JoseTapia
State of Fbdda
My Commission Expires 041131201 B
V"OF F�Oa' Commission No. FF 109909