HomeMy WebLinkAboutCHANGE OF CONTRACTORSCANNED
BY
PLANNING & DEVELOPMENT SERVICE§t- Lucie County
BUILDING & ZONING DIVISION
y 2300 VIRGINIA AVE RecfveD
- - — - FORT PIERCE, FL 34982
FfB 12 pig
(772) 462-1553 FAX 462-1578 Perinittin
SC (,O9e ctartrnent
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
com encing 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: F'eh 1 Z t 2019
Permit Number: S 1<C 1 ((�)C)eA — 0,1Q1
Site Address: G 0 r_p7C) & nC CC. n J�) Y . J CYVSCYI 9�;PdlCrl
(1ilcy n Y_n I9112�Y- I—M _1C_11IC0"h testate LicenseEClQZ 1.0%Q SLC License
Original GC, subcontractor or ownerlbuilder
(SI I�.�Y' n C a ��f'1�' c�a;q f t _State Licensek��SLC License I l`�1SJ
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, fe amages ising from any and all claims of action for any reason, which may arise as a result of this change of
contract(r/subcontracVr or cancellation of permit. A permit cannot be cancelled if work has been performed.
PRINT RM-n-"-1 II(AY Y III \I
State ofFlorida;County of St. Lucie County 1
The following instrument was ack��noo]w]lodged before me this
k'L�ayOf�_,201`�t.
/ by i in
Ttf�l, V 2who is personally known to me
who has q�ace l as ID.
/ 1 V 1! 4 r, .l
Tgoat.m of Notary Date
SIGNATURE GENERAL
,COONTRRA,CJf CONTRACTOR (or
new ^Cam, ., applicable)
PRINTNAME Gt A Y 1 Y 1 C.k/I1�Y /1'
State of Florida- County of St Lucie County
led
1� /` ayCofpi I�, cut was 20lin�ybyi
Y\ l\ lY whloo is s personally known to
\�owho hx_ srttroduced. skip.V\
1/�SFg� nature ofUlNotary �1 1� Date
Revised 04/15/1
�,pON Notary Publie Sato of Flodde �o+r Notary Pubic State of F orida
Hablah Wnaor Habiah Winaor
My Commission GG 107386 +A My Comm4alon G0107366
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