HomeMy WebLinkAboutCHANGE OF CONTRACTORSCi N igED
PLANNING & DEVELOPMENT SERVICE�t. L ie COU
BUILDING & ZONING DIVISION .,`7
2300 VIRGINIA AVE �a''v,�FF 2
FORT PIERCE, FL 34982 tir9a •moo
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(772) 462-1553 FAX 462-1578
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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
co nencing any work. There is a $50.00 fee for the Change of Contractor.
7/� 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: 'r-rh 1212()1G1
Permit Number: SLC � W4—n6�3W`2
SiteAddress: l girl a li5O S n occon )4 . sj n c h V� Cac,) , --ti
CA)MY) W I S—CVV1- f M C., State LicenseECXJX L�7_1lIA8LC License �v�Z
Original GC, subcontractor or owner/builder
Cklfy�rnY-ok - . �iYl/teD`� State JCAEY4l LCLicense-3)QC9q
New GC, subcontractor /�
Reason for Cancellation l V I A
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or dam a es arising from any and all claims of action for any reason, which may arise as a result of this change of
comractopilgftcorftractorr cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE ^R(or omerlbuiilldeerr)�r�o, SIGNA GE(N�ERALL'COO �/� CTOR(or new GC, aasaapplicable)
PRINT NAM• [Jti( 11 [T /C-r.\I PRINTNAME C-11e 11 t
Revised 04/15/16
pP Notary Pula t: State of Florida
Hatalgh VOW
+A My Commluion GG 107386
gapo� Expires 08W12021
lowing twas az)Mlcd this
1dayof rn20 by
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who is personally known to
` or o ha. roductp ed�ac�
�.Stgttstorre of Notary Jn`_L•1'1/At Date
Het�el0ryttpiubk State of Florida
+}p Mycornallsalon 3 107386
•dIR �Uaatl6/27/2021