HomeMy WebLinkAboutCHANGE OF CONTRACTOR 1-10-20SCANNED
BY
PLANNING & DEVELOPMENT SERVICES'] Lucie County
BUILDING & ZONING DIVISIC N RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 JAN 10 ^01'3
(772) 462-1553 FAX 462-1578 ST. Lucie County, Permitting
SCANNED
BY
PLEASE SELECT ONE OF THE FOLLOWING: St. Lucie Countyy
_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
comme ' g 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:
Site Address:
e? S
Original GC, subcontractor or owner/builder
Permit Number: N(05 — CzS
License SLC License
ME14,,., eOSte_ J21EIAtAk4{ State License C 15I VI!SLCLicense t�
New GC, subcontractor ry (�
Reason for Cancellation
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) SIGNATURE GENE�RRAL�CONTRACTOR t,or new GC, as applicable)
PRINT NAME PRINT NAME t`V�5&eV_i
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
20— by
who is personally (mown to me
or who has produced as m.
Signature of Notary Date
Revised 04/15/16
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me thus
a �day of �,r. .20ad by ro� e
V'I"Ci*dNN who is personally known to
`fie or who has produced tk t\ LL as m.
Signature of Notary Date