HomeMy WebLinkAboutProject Information PLANNING&DEVELOPMENT SERVICES
-sip No BUILDING&ZONING DIVISION
L „ 2300 VIRGINIA AVE..... o
FORT PIERCE,;FL 34982
(772).462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE:SEtECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR-+Change of Contractor is to be.signed and notarized by the property owner,
and the,new contractoupfrecord for the current permit..A new permit;application must also be completed with new
contractor Ynformatiori and signature.,A new Noticeof 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,frll out a Subcontractor Agreement Form.There is a$50*0 fee1or the Change of Su
Contractor.
X 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:' i7MT/i6 Permit Numbe
>�3�803��'r�
SiteAddress: 6105 RAINTIIEE:TRAIL<FORT PIERCE,FL 34982
GENESIS PLUMBING State License SLC License
. .
Original GC,subcontractor or owner/builder
State tieense SLC L-icense
New GG,subcontractor
Reason for Cancellation NTNLPRI_OR�Q.!?iIJLLMGr NEVYilPERMt3�# 6Q3.O+t23
The undersi ed:does
gn . hereby agree to indetnnify:and hold harmless St Lucie County,its officers,Agents'anil employees from all
-costs,fees or damages arising'from any and all claims of action for any reason,which mayarisem a-result of this,change of
contractor/subcontractor or cancellation of
permit.,A per.mit cannot be cancelled 3f work has been;perfgrated;
SIGNATURE OF OwNER(or owneribuildet) SIGNATURE GENERAL:CONTRACTOR-(oi iiew GC,as applicable)
.PRINT NMR-FL-1 7. 4-t &rH l_.Jgsit)s PRINT NAME-'
;State_of Florida,County of,Sts Lucie County State of Florida,County of St.Lucie County
The fgliowing nstnwcnt was acknowledged before me this: The following instrument was a6knowledgedbefore me this.
day'of• .2p�bY day of-20. by
who is petsbnatly known to me -who is,personally known to
or who has produced as ID. me or who has produced as 1D:
Signature of Notary' Date. Signature of Notary Date
i
[revised 09!1$116 � 2