HomeMy WebLinkAboutMisc Letters (2) Aug 26 2016 01:41PM HP Fax01neya Restoration 7722618839 page 1
PLANNING&DEVELOPMENT SERVICES
.::.a ; ,-; 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 AIC 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.
C cellation 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: Z I l Permit Number: -'l C- I oD,?' 66
Site Address: ��rQk�c�Kx - Fz�- Peirce fC,
Ne •+ LaL State License M-1336-75 i SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation �-a=n�`4P[� �� C�' +`-Vn �1 P-Lav e 2_
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/subcontractorlor cancellation of pennit.A permit cannot be cancelled if work has been performed.
S1dN`kJ7URE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME QVZi�t. I _It w � PRINT NAME
state of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instmment was ar:lmowledged before me this The following instrumeat was acknowledged before me this
Y o 204{,0,by _ day of 20_,by
i i �•4 ,�; .. l l c' who i rsonally]atawh to me who is personally known to
or•who has produced as ID. me or who has produced as ID.
Signature of Notary Date SWtawre of Notary Date
�1`,
PAUTAFERAANTE
' MY CO.NiNiISSIDN @ FF 022100
Revised / 3 EXPIRES:May 26,2017.
�',+�•'�F��o' gprded Thru Mniary Fut�.Unde+vrers