HomeMy WebLinkAboutCHANGE OF CONTRACTORBY
St. Lucie (
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION I RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 J.4N 3 1
(772) 462-1553 FAX 462-1578 I eT% Ee,ld Faunty, Permitting
PLEASE SELECT ONE OF THE FOLLOWING:
_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 PERNHT — 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: .131- 2 W
Permit Number: 6, I,G
Site Address: 2 ��Le xbc Oi S lS )YL . /902 f eQ
c5 (�,Yf MAgrati, 3XStateLicense SLC License
Original GC, subcontractor or owner/builder
M1C)"i, I�'\in�--i 'c State License SLC License
New GC, subcontractor
Reason for
C_
C'OL�p
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) i SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME M IGI4LG n,l [)Z�i1 -:te-� PRINTNAME
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
j day oFA'C� .20_b3rLclyte
who is personally known to me
or who has produced %t. Q L, as ID.
p NAMARIEGNENS
MY COMIdISS1ON # GG 022023
L 6 ExpIRES: December is.2020
Sonded Thru Notary Publm underwriters
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
_day of 20_, by
who is personally known to
me or who has produced w ID.
Signature of Notary Date