HomeMy WebLinkAboutChange of Contractor To: Deanna St Lucie County Page 2 of 3 2017-08-04 20:19:53(GMT) 12293294104 From:Todd RHyne
BUMPING&ZONI G DIVISION
. 2306- V'TRRC TNt.A AVE
FORT FIE'RCE,FL 34982
77 4621553 F '462=157:8 �O
( , )
G
CHANCE'®F CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT ��o
PLEAS1r.,-SE1.Yff ONE OF THE FaT I_0Zr1NG:
T.I aCTOIt-..Chalige-..f Contractor is to be signed.and-notaari .e..d by;the:grogeriy owner;
at3ti the xtew'carttractorof record for ills current'permzt t1 mew.permit application.must.also be.completed
with new.
butrat tc r'infilrmation dnd si6.iature .A.new.'Nct6*of!Conant nc�megtpatist:be filed in the.3iew� contractor':s name.
dor job: aluss:;greater than,$2,,5 0 .($7x5.0!1. if.�ti/C Change-out). A recorded ropy rrcilsc be sulimittec prier to:commencin�;.:atty woxk:.'Tlaere. s:a$501.00 fee'forthe.cbAnge d contractor..
CHANGF,OF'S.UUCOl -TRA(.-.T..OR—SubconE�actar ehanges•are to be signed.by-the-general contiactor oni y
The new subcontractor must fill.out.a Subcontractor Agreement Form wl'trch is-signeil by'both the contractor and
subcontractor,.There-is.a:$50.00-fee for:the_:CharigeWSub.:Ontractor..
CANC LLATION OF PERMIT—The Gancellatign.of a:permit is.acceptable only if-no work has bein.dolle, .....
Cancellation.ofPermif.is'to be signed.and:notari ,y
permit q 4 ual.ar:ofrecord.47f'laere is 7ao:fee.,or
.eanceH400U:of tlae Permit.
�Rtd: l 4 ber � -F !y�-f'
11
? .' i'e>rtaeitl�U>laa �� � tE —
%te.l�dda ss• , ll 7Qwy 4 1
State.License ^SLC.License
Or al
G.C;su4contractor or ow.ner/builder
.. ................ . State, icense
—SLC:License
New:GC,subcontractor or ownerlbuilder.
Reason for Cancellaiiva__,__,., _ --
`l7Ke.-'lmdersigrxed does_hereby agree io indetnttify and;#toltl;:ltarmless-St Lucie County,its Uf ce.�,agents:and.empl4Yees frQm.atl
i osts fees or:damages.arising from.any and`a l claims of acnan for any zeason,whickt-tn,a}ante as a result of this:change of
torts con for of canvellatiou of I A:hermit cannot. led if w as a perf4rtned,
44,
ENER.AI:.CQNTRA.:TC)R nGC,as:apJible
`rr y /�� ItINxNAME - 1 PI A
-..^^^_--`
Slate otT.Larida,;.Couniy.nf St LucieQ.sunry ;Slate r�c'filoada•Couaty of:St. �:c c.County.
7he.f01,4�vingins �mentwas.acknouecigedhefoce:ruetYiis. "aet��owtnginti ctts�2sacknowlbctgcd'6elon.uiethi
�r�?," is '. "Who icr=atnolynme
o s l 'to
Put-,
':
,, aMte�s personally kncnn'to
'".. F,.
���o has produced .7. C Fps ,. ;n , w1io has and r ,_—as lA_
h 7 '
5' `#!moi. _5,,v
_ Date.
i5" t' e4f4btgry ' .
vis�cX 05J18%201i .y v; „ T.ClALYNN:HENDERSQ\'
MT t�Glz[y?tlN.iC.,:518(f.otf!Cooa
_ . � �' la'+TfI!I`+r"Ofi yti3�:r.`3i�..
t t-` M1".y.Comm.Cxpires1u12Q,'2021
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