HomeMy WebLinkAboutMisc Letters Dec 19 16,03:54p Genesis Plumbing 7723352680 p.2
PLANNING & DEVELOPA'I:ENT 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 S50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be completed by the general contractor.
The new subcontractor must till out a Subcontractor Agreement Form.There is a$50.00 fee for the Change of Sub-
Contraetor.
CANCELLATION OF PERMIT—The cancellation of a permitis 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 off the permit.
Date: l�1 Permit Number:
Site Address:
i ,Li.► �c owlU 1 Cq:�
s�Ce+,te LicenseC �C License
Original GC.subcontractor oro erlbuilder
State License SLC License
New GC,subcontractor
Reason for Cancellation � Il C'�`1 t��`�.� '� Liao`�
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 permit.A permit cannot be cancelled if work has been performed. r
SIGNATURE OF OVNElt(or oNvuenbuilder) ATLRE GENERAL CO7; AC.To1R(or new GC,asap Ief
.�{ I
PRI.1T NARE PRINT N ANTE
4 J
State of Florida,County of St.Lucie County State o['Florida,County of St.Lucie County
The following instrumentN%ns acknowledged before rte this ] followin tnr t was ac:k;.oxvledaed before me this
day of �0 by da}of �� _ ,20 by
rI l
`who is personally knov n to me '. i �\ S << `\ who is ersonall}kao. to
or who has produced as;D, me or Nv o has produFcd ID.
Signature of Notary Date Signa rc of Noulry Date
MARIAIi M L"
Cammisslon o FF1123763 M
Revised oaiisilu '?;.• Expires June 3,2017
R$4 Ba edthuT FaoNsorarteft�3F57t11? C—)