HomeMy WebLinkAboutChange of Contractor Planning&Development Services
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Building& Code Regulations DivisI
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'Z15 4 7Z 2300 Virginia Ave.
Fort Pierce,FL 34982
(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 becompleted by the general contractor.
The new subcontractor must fill out a Sub-Contractor 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: s ?i l 6 Permit Number:
Site Address: 2�cn—
� n� _ q �s
�r'l W � `l State License SLC License
Original GC, sublontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless Sti, 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.
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SIGNATURE OF O�WNER-(or owner ilder) ATU12E GENERAL CONTRA O (or new GC,as ap licable)
PRINT NAME - `p PRINT NAMErl - L✓�
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State of Florida,County of St.Lucie County State of Florida,County of St.Lucie��County
The following instrument was acknowledged before met this The following instrument was aclno, ledged before me this
day of 20W,by •b. day of 20 b C
�^� 1vha is personally know to me ����,ej�9�S ,who is per know to me
r w oduced ID. or who produced I as `^
Signature of Notarya .gnature of Notary D
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ANA`JlAd lbFINSOfU �tiq�k,tuc ��lA MARIA JOHNSON
NOTARY PUBLICI�OTARY PUBLIC
' -.®STATE OF FLORIDA Q--t" =STATE OF FLORIDA
Revise Comte#FF054223 Comm#FF054223
`� t��° Ex0res 9/16/2017 j-p I�t�tExpir®a 9/16/2W 4 7