HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & DEVELOPMENT SE ECEIVED
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE MAR 14 2019
FORT PIERCE, FL 34982 5T. wcie county, Permitting
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING: SCANNEDBY
CHANGE OF CONTRACTOR — Change of Contractor is to be signe$611 gof i ytthe property owner,
and the new contractor of record for the current permit. A new permit application must also be dgmpleted 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.
ancellation 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: 3 — 1 �1 — 2-0 t / Permit Number:
Site Address:
C_ State License SLC License 2?55 &
State License SLC License
New GC, subcontractor
f
Reason for Cancellation
54
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 be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) L NAT[JRF:6 /' BPFFAA7E�'9FF(orneW"GL pplicabley Q�o.gb�Tq
PRINT NAME PRINTNAMF G �� ) �i S SJ J
State of Florida, County of St Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
20— by
who is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
T�following instrument was acknowledged before me thus
day, of tNo! _20A by 6Ya 01
who is personally known to
me or who has pr aced !E"L 1 - as ID.
y.r-�•-� 3 � 1 y � 19
Signature of Notary
1ti......EM]
ARIEGNENSIDNNGG 022023ecember 16,2020Public Undetwdtarsary
RECEIVED
MAR 14 Z019
ST. Lucie Count ,� NFR119-KRO
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