HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION <� F2
2300 VIRGINIA AVE �t2 �O
FORT PIERCE, FL 34982 �0�9° .. •Ion
(772) 462-1553 FAX 462-1578 " oPgdr
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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,
tU o and the new contractor of record for the current permit. A new permit application must also be completed with new
Z} contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
m v for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
Nco ome ncing 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.
C* 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: Eh 11, %O kCA
Permit Number: S Lc 1 g)®e� `O"12'1
SitepAyddre�ss/: 7� 1 OO MlIrlu+F M1a C� �L� t O-YA- p1'`PyU 19,
C�1� T 1^(i l Jt�EQ'V —_Tu� t9 C�rY�r i State Licens_ef CAih72t'--0V SLC License L
Original GC, s�ub�contractorpr own r�ut�G-MvuN, (nl OW) k Sf fi' cT V\�%1 C� State LicensFICk3C0941-1 SLC License �(Dty —I n
New GC, subcontractor
Reason for Cancellation
ersigne hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
fees or damages rising from any and all claims of action for any reason, which may arise as a result of this change of
Ictor/subcontract or cancellation of permit. A permit cannot be cancelled if work has been performed.
Sl(iNATUR medbuilder) S1GNA(E�NERAAL��C�O�/N�TRACCTTOOR((oor nnm GC, as applicable)
PRINT D PRINTNAMOl'Itlir [t I F-klt �.�./r
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
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