HomeMy WebLinkAboutCHANGE OF CONTRACTORF) 0
PLANNING & DEVELOPMENT SERVICES
i BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE, FL 34982 DEC 0 4 2018
(772)462-1553 FAX 462-1578
SCANNED ST. Lucie County, Permitting
BY
St. LUCDNdE 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
conlyiencing 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: 1A - � l 9
New GC,
Reason for Cancellation
Permit Number:
Ahq, Z
License SLC License
License' 2C SLC License
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
contractor/subcontractor or cancellation of permit. A permit cannot ncelled if worlq has een performed.
7e.�C'/L2li
SIGNATURE OF OWNER (or owner/builder) SIG ATUREG CO CTO new GC,asapplimble)
PRINT NAME RW"I'NANE 'Ir�
State of Florida, County of St. Lucie County
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this a ollowing' ent was aclnowledgpibelme me this
_day of 20_ by day of . 20-, by L kev
who is personally known to me who' gasonal own to
or who has produced as ID.
Signature of Notary Date ,
Revised 04/15/16
me or who p uced ID.
Signature of Notary Date
KAREN-S..N L
i¢? State of Florida-NotaryPub] c ..
R. Commission N GG 207484
My Commission Expires
June 12, n