HomeMy WebLinkAboutChange of Contractor PLANNING&DEVELOPMENT SERVI($�
BUILDING &ZONING DMSION ell,
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1579
CHANCE OF CONM&CTOR.gMC=MCT0A OR CANCELLATION OF LRRMT
RLEASPSELQQ_Z }NE 4 T4 FOLLOWING!
CHANGE OF CONTRACTOR.-Change of Contractor is to be signed and notarized by the propefty 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$$0.00 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.
i/ 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:10-1+i Permit Number: (02
Site Address: 1174
_State License W05,4J.0 SLC License
Original CC,sub6ontractor or owner/builder
State,License -SLC License
New GC,subcontreAor
Reason for Cancellation hfiu GlrflLGy e4--X&Ale
The undexsigr�ed do—as Lucie 6iiixit—y,its officers,7g—ent—smd;7p—loyeas 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
b
oontrmac
,;m*u contractor ancellafion of permit,A permit cannot be C"
SIONATL&OF dWRE—R(or ouner/buildor) SIGNATUU OMRAL C4NTRAC fOR(or now GC,as applicable)
PRINT NAME L r L, PMT NAME �MM 0 11�5-
-LLJ 15 15�fl Yh M 0 A �_�ri
Suge of Florida,County ofSt,Luck County Staw of Florida,County of St Lucia County
The following iriMmou was aclaww1nigod before me this. The following instrument was acknowledged before me this
--LO day of �4 t 2016 by _0 day of blWt .20—)' by_
, _ —2
dita7".5 SAMMP&r, whoIspersonallyknowntome LL AT,s fiftio e 4 4 who 11;pamnwly known to
or who huzproducWW_aws ID. me or who�=produced ID. —
SicnatareoiNovr Date We
Y
Revised 04/15/16
EXPIRES:AptU4,1017 EXPIRES-Apill 4,2017