HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT
BUILDING & ZONING DIVISIO:
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEA ESELECTONEOFTHEFOLLOWING:
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.
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 SCANNED Date: 2l 63 /�� St. LUC e CC- DUnly Permit Number: §�(eCq - 0 350
Site Address: 4coo M . A IA E E7 P 12L (fE F-C 3 YLT I %
eA or) (0 5 lk?S 6vuP State License SLC License
Original GC, subcontractor or owner/builder
AWCC-anE7atlfonmenfa l2e5fvra;6,W State LicenseS(f/ 75(0
SLC License
New GC, subcontractor
Reason for Cancellation 0l1!gt/tit(' 6 C
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from
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
cwntrac r/subc at for or cancellation of permit. A permit cannot be cancelled ii/f/pp/j,work his en performed.
IGN EOFO ER/(or er/buildf7er) SI ATURE GENERAL CONTR1A/CT (or new
—�GC, asapplicable)
PRINT NAME L L PRRJTNAME TV4La lM' KkPa:
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The� lowing ins mere[ was acknowledg afore me this following instp{me was ack��nohhy''''ledged afore (ne tbb y(
i'L dayof�-20_ by It aZ f G�4
Ldayof Ty A420A, t .Ik L�I_y ti1�
I who i ua l�:e lly,ka_= «uylly kaQ tt0 me
11
who has producee.
Notary Date I
Revised 04/15/16
JULIE BARRETT
y. Notary Public. State of Florida
Commsion At GG 243242
My Comm.sExpi es Sep 28, 2022
Bonded through National Notary Assn.
-- -- who is personally known to' —
me or who has produced/ as to.
1_�
Signature
:oM� Notary Public State of Florida
Richard L Mines Jr
My commission FF 978335
orn Expires 0529202o