HomeMy WebLinkAboutMisc Letters Aug 26 2016 01:31PM HP Fax01neya Restoration 7722618839 page ?_
1
PLANNING&DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772) 462-1553 FAX 462-1578
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.
1 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.
Cadcellation 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. g I-RS1 I 12 Permit Number:=S1 f=- 11oQ?-66
I
Site Address: � � QL_I�I7LrK Tiy-dr Pievre- ft.
K� C7 LLL State License Cal 33C7S l SLC License
Original GC,subcontractor or ownerlbuilder
State License SLC License
New GC,subcontractor
Reason for Cancellation (l-n o ��� C 4 c - 1�i s�kh ` — �l(�t��t?!Z .
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents atxi 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.
•1, `tom_-..^-�------
SIGNA OF OWNER(or owneribuilder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT,NAME -_t� -tI _�L�✓000wL{,ti PRLNTNAME
State of Florida,County of St.Lucie County State of Florida,County of 5t Lucie County
The following instrument was admowledged before me this The following instrument was aclmowledged before me this
y of�taa 20j U_by-- , day of .20_,by
17 1 wfio is personally kno%m to
ofwho hes produced as ID.. me or Who has produced as ID.
bii au of Notary Dates Signature of Notary Dune
RGVi3ed 04/15/16
I