HomeMy WebLinkAboutCHANGE OF CONTRACTOR0
PLANNING & DEVELOPMENT
BUILDING & ZONING DIVISIO]
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
IWEIVED
OCT 17 2018
Permitting Department
L St. Lucie County, FL
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
SCANNED
PLEASY&ELECT ONE OF THE FOLLOWfNG: By
St. L e
CHANGE OF CONTRACTOR - Change of Contractor is to be signUedC1anFn0oY=d 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 Cominencement 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 PERAUT - The cancellation of a permit is acceptable only if no work has been done.
Canceliation 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:
10/15/18 Permit Number: 1809-0215
Site Address: 16 5-0 b I C, I o tz 6 10 '(M . 667ace , 1:�L 3qq2-2-
Original GC, subcontractor or owner/builder
DAVID PERRYMAN
New GC, subcontractor
Reason for Cancellation
License CBC1260887 SLC License
License CBC1265490 SLC License
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its 0-tlicers, agents and employees from all
fr n' c aims of action fiorN rce:nson ruCy Aise as a result of this change of
rif mitea, ce,lwhich,
'a a
in
Clo�,�tl�'cetorlo�-co-\tr�a,eestor -coelml�ataiinc)ynaof�pae'rmilt. A per Ze ed i ork s been performed.
SI NATURE OF 011TER (orkner/builder) V%041fftlkli GENVRAL CONTRACok (or new GC, as applicable)
PRINT NAME f A 26f"
S&I K- 'IJZAN :I+ t PRlNTNAME.D_AUfJ? t'36
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this The following instrument was ackri ledged befi�re trip this -1 Wall
(0 day of 6 Cb IPC(- 20_Q6_ by -Fr 7wby
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who is personally known to me
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9 Notary Date
TIFFANY COMA
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who is personally known to
me or who has produced as 11).
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"IAotary Date
Signature o
STACYSELMORE
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X-01 EXPIRES: NOVOMbOrS.2019
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