HomeMy WebLinkAboutChange of Contractor RECEIVED
JUL 20 2018
rF Planning&Development Services I ST. Lucie County, RQrmitting
->r Building&`Code Regulations Division
23.00 Virguiia Ave-
FortPierce,FL 34982
— _ (772)462-1553 Fax 462-1578
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CHANGE OF CONTRACTOR bYY10L
Or Subcontractor or Cancellation of Permit
Change of Contractor is to be completed 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,
signature, and transfer fee. 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. Subcontractor 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: '2o l Permit Number: I V� _c) �J
Site Address: 6707 `tom CLarq- 1 J l 1/C -F4• Fil ed-C e- FL 2i'�,57
c + State Licens CO �C Licenseu g 8q2�
Original General Contractor(or Subcontractor)
State License SLC License-,
New General Contractor(or Subcontractor) �
Reason for Changeoy, rqe1rakJ aa3fl'1k c �mx �
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 ermit cannot be cancelled if work has been performed.
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SIGNATURE OF OWNER (or o^wneer/b�uildeerr),1 *SIGNATURE O EW GENERAL CONTRACTOR
PRINT NAME II L /l A (/`y�Y` PRINT NAME ,
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
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w s personally know to me who is mortally know to me
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Donded Thor Alowq Pubic Underwriters1i° w 6.2019
Revised 07/21