HomeMy WebLinkAboutCHANGE OF CONTRACTORgo? - cuq
PLANNING & DEVELOPMENT SERVICES
LEIA 11-41 BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 4�2-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEOE SELECT ONE OF THE FOLLOWING:
anhCHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
he 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
commencing 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: 11 - 12 — 76 1 V
Site Address: /go
Permit Number: 18 000- 0 6,�-
State License SLC License
Original GC, subcontractor or owner/builder
D(Z Uou�,f r&C, State License SLC License aqs-6so�—
New GC,
Reason for Cancellation oo� ottoktuched- 4M i%y&xr,jEAe
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
costs, fees or damages arising from any and all claims of action for any reason, hi h a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if w has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATUhA Or
,P1 ACTOR (ornew GC, as applicable)
PRINT NAME
State of Florida, County of St. Lucie County
'Me following instrument was acknowledged before me this
— day of 20_ by
is personally known to me
or who has produced_as D).
Signature of Notary Date
Revised 04/15/16 SCANNED
BY
St. Lucie County
State of Florida, County of St Lucie County
911owing Ptiurnent was ackn9w1ed beforp me this
-day of W
who is Personally known to
IffeNor who has produ ID.
_�Ignature of Notary Date
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Notaly public DGC 20 2016
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