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.� Building&Code,Regulations Division
E 2300 Virginia.kve.
. 'Fort Fierce,FL 34982 :
(772)462-1553 Pax 462-1578
CHANGE QF CO
Or Subcontractor ` Cancellation of Perm
Change of Contractor is to be complete l bythe property o. , wcontractor.of record for the
current permit. A new permit application must:also'be completed vriih new contractor information,
signature; and transfer fee. A neve Notice-of Commencement must be filed'in the new.contractor's
name for job values greater than $2;500 ($7,500 M A/C Change-out). A recor t 'd copy dust be
submitted
prior..to commencing any Work. Sulicontractor changes can be,completed.by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to .be executed by both the
owner and qualifier.of record.
Date: 1 6 9 Permit Number:. oq
Site Address- 'e1 '1" FYI YI : .n , UJ 4
firtme-la Ploaki ( kleLiVe ,et� :I:g I Sq S(.oSLC License
Original General Contractor(or Sub tractor)
i
State License SLC License
New General Contractor(or Subcontractor) ,f
Reason for Change l_Clf 1 t'e I e t- , ( Co.
r�vS 1
The undersigned does.herebyagree to indernnify.and hold'liarmless 5t:Lucie County,its officers; A'li �-
agents,and employees from all costs,fees,or damages arising from ariy:and'all jplairYis of action for
any reasoin,which may arise as a;result:of this.change iaf:.contractorlsut�contractor:or cancellation of
permit. A permit cannot be caiiceiled if}work has been performed..
SIGNATURE OF-OWWNEk(or owner/buildee)' 'SIGNATUR&OFNEWGENERAL,CONTRACTOR-
PRINT NAM9V Oft ( CC.ti� V` P.RINTNAIvIE
State of Florida,.County.of St.Lucie County State:of Florida,County of St.Lucie County
The followinginstrunientwas aclmowled before e:tbis The-following_instiumentwas ackaowledged.beforemethis
day of 20 byGZ.'( day of 20_by
who' �ersonaliy,kn to ma who is Personallylaiow'to hie
orwh s. raduced as orwho hasproduced as ID.
13/JA
Signature y
ature of No Date Signature of Notary Date
*Only signature required .for change of subcontractor
Revised'�07/21/14 COt8MCN1841tin .
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