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Building &.Code Regulations Division
2300 Virginia Ave.
• ► Fort Pierce,FL 34982
(772)462-1553 Fax 462-1578
CHANGE.OF CONTRACTOR
Or Subcontractor or. ancellatio' 'Permit'`
Change of Contractor is to be cornpletedby 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 AJC 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.
' 1
Permit .Number:.
l _
Site,Address: . UYl S �l C`
9 ` State_License . p T�3u b�LC License x
Otigikal I 6--neral Cointractor.(orSubcontractor)
State License SLC License
New'General Contractor-_(or Subcontractor).
Reason for Change ��{�. A "'CA(_ ae
Ir
The-undersigned does.hereby agree toindemnify and.hold harmless St. Lucie County,its:officers,:
age and.employees from all costs, fees,or damages arising from any and all-claims ofaction for
reasop,which may arise as a result of this change of contractor/subcontractor or-cancellation of
ermit:. A er 'tcannot. a cancelled if work has been perfor e .
5 A OWNER-(or owner/builder) " Arup OF NE W'GENERAL CONTRACTOR 4'
PRI NAMEo !(1!c. J -1L'c PRINT.NAME
State of Florida,-County of st.Lucie County State.of Florida,County of St.Lucie County
The ollowmg in ent was acknowledgW before me this T e f llowing m ment was-ackno vledged beforeme
day of 1 ,•,20j� by � 6 day of _,20�.by
/. mhos per onally,know-to' a who is' onally, me.
or iv l produced as or who hs duc d as
ignature of Notary Date Signature of Notary Date
*Only signature required for change of subcontractor 1
Revised 07/21 ?/14 � h�`11NlCOie McMahon ��1 '•�' 6'i'4 wole M-Mahon
yam'S'Commission FF945187 ti
'�" iresNovember 19 2019 '* Commissloli n FF9451Q!
LEzpires:,November 19,:2010
Sanded thiihbnKOM °, �� �'" Bonded thru Aaron Notan,
'a„m �>�