HomeMy WebLinkAboutMisc Letters Planning & Development Services
- _ Building& Code Regulations Division
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2300 Virginia Ave. NOV 6 2Q16
• Fort Pierce FL 34982
(772)462-1553 Fax 462-1578 PER r
St. Lucie County, FL
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 Sub-Contractor Agreement Form. There is a$50.00 fee for the Change of Sub-
Contractor.
1 A 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: Permit Number:
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Site Address: (� �� 2 ro IL l Aas F>! 3 c,
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A4tfioo� Ad v G P-�-oUy State License SLC License
Original GC, subcontractor or owner/builder
A /) 0 )'�_01� R 00 1 r State License SLC License
New GC, subcontractor _l I
Reason for Cancellation `L N 5 d �a n� 1 C I E +
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
1pelA ermit itcannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME 140 1446 `S�J OPn/ PRINTNAME
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State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowled d be re me this The following instrument was acknowledged before me this
day of20 1(pby JA.Aft, day of .20by
UT 1 1 In V 1 17-
P( � who is personally know to me who is personally know to me
or who h oduced as ID. or who has produced as ID.
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' KAREN S. NIELSEN ry
Signature of Notary '°8� Si ature of Nota Date
Commission N FF 115637
„r My Commission Expires
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Revised 04/15/16 June 12, 2018