HomeMy WebLinkAboutCHANGE OF CONTRACTORA
PLANNING & DEVELOPMENT S]
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462_1578
CEIVED
OCT 1.7 2018
Permitting Department
St. Lucie County, FL
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASRSELECT ONE OF THE FOLLOWING:
t/—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
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.
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 PermitNumber: 1809-0218
SiteAddress: 165V Dt6f0a61012d.
STEPHANIEWALTON State License- CBC1260887 SLC License
Original GC, subcontractor or owneribuilder
DAVID PERRYMAN State License CBC1255490 SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
sts., ees or age ; a from any and all claims f act. , fibryll reasoni �iay arise as a result of this change of
if
.torl. u cane r
co �afcl ractor r cellation of permit. A poermitocnan el k ha's been performed.
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SIGIATURE OF OV7VER (or owrieribuilder) IGN.4 TURE GENERAL CONVFACTOR �(or new GC, as applicable)
PRINT NAMEF POULP
apoL(_�CWt PRINT NAME
State of Florida, County of St. Lucie County State of Florida, County of St Lucie County
The following instrument was acknowledged before me this ne following instrqment was acknowledged before np this
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