HomeMy WebLinkAboutCHANGE OF CONTRACTOR�1 ,ANNING & DEVELOPMENTSrAVICES
BUILDING & ZONING DIVISIONFFEB
CEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 11 2020
(772) 462-1553 FAX 462-1578 county, Perr
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
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 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.
S
Date: 1/29/2020 St Cq/j/� Permit Number:
Site Address' 10410 S Ocean Drive #706 Cn
Nathan Cooke
Original GC, subcontractor or owner/builder
1910-0497
License SLC License
Katherine LaDeene Dodson - Agler Kitchen, Bath & Floors State License CBC125G637 SLC License
New GC, subcontractor
Reason for Cancellation Orginal contractor can't get to the work.
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.
wt' (or o%her/builder) SIGNATURE GENERAL CONTRACTOR (m new GC, as applica )
State of Florida, County of St Lucie County
The following instrument was admowledged before me this
day, of JO fl11 .20�W by
MIA 11 Ih •l who is pmsoLfly known to me
m who kas radon PT1 IWA as ID.
1/2ra9/2020
Signature of Notary Date
Revised 04/90:3
FREUDEN0IALn# GG 169506ecetnber19,2021Tb19lmrFainbmranm
Katherine LaDeene Dodson
State of Florida, County of St Lucie County
lowing instrument was acl1oo��o��wledg befo me tlils
day of .lamg 20R by q�[�,
Laft,8 �O(kA'1( J who is personanv Imown to
0 o has rodpc� 0ID.
0 1/29/2020
Signature of Notary Date
SANDY M. FREUDENTHAL
Commission # GG 169508
:• I Expires December 19, 2021
'•':•a ijS" BadedThm TmT Fain /tnranoa800d9'7019
N so
_ PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 Fa
(772) 462-1553 FAX 462-1578
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 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: 21 \2, 7Z Permit Number: \ 0t\o— 040(1—
Site1�A-�ddress: \04X0 S- Q(.( &e Vft• '�' 1" %C, lZi.R.G41, fl,
tX 4i C\t& V1 L I \nL State License SLC License
Original GC subcontractor or owneerr/b-u-il(d�er
��,VyVe 04. MN &X t5 F/fit t �— State License ' SLC License
New GC, subcontriktor
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.
4ra
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of 20� by
is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
PRINT NAME
State of Florida, County of St. Lucie County
The-fallowingm'strument was acknowledged before me this
Z day of , 20Z_Qby ls, , L
LA WA L I)VAI 1n who is persona ly kngua to
e or who has rod c as ID.
2� 12 1'IA
Signature of Notary Date
. .,_ SMY M. FREUDEHTNN.
Commission 4 GG 16M
;r,d Expires December19.2021
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