HomeMy WebLinkAboutChange of Contractor (2) n
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CHfI' GE.:.OF CC?1TRAG�TOR.SUB�COl2ACTOR OiI CA1�C�EiCLA`�'IQ f1r PEIIM`
PLEASE•SElECT_DNE OF
THE.FOEZOWING:
=CHtNCE OF CONTRACTOR Change ofContractor7s to-be signed and nolanzed'by the property owner,
;at�d�e-�evu contractor ofzecord fare current perffut Anew;per�ni��appbcation,mush also ire eomp�e�ec tuitlY neEcr
cbnfcaetor,ufOrirlaton�Indstliature. Anew Notice of Comiriencemotit`must`be veil tie clew,cantractot�'s tYamo
>or,jab values,greater than $2,SOU {$?,500 A/C Cb{angee-;out) A recorded .opy :iiust be subriitted prior to'
erammeneanguny work Thee rua'.SSQ.OQ fee for-the,Gfiange-of Contraetor_
CHANGE OY+'S[�BCOI`TTRACTLR=Subcontractor:changes;are to be completed by the?general contractor::
"ffieaew subcontractor musti' ill out a,Subcontractor Agrtemeii<t Foam.there a S5.O�b.,0 fec: or ti Change of 5ubi
�Contratcfoi�: ,
CAcNCELLATION`OF PERMIT•—The cancellahbn of a petrnt is acceptable only fno work has been done
Cancellatton of permit ss to be sigtied and notarized by`bath the owner and: ua' if Jlterl,df record. Tliere U.no fee=for'
cnceyIahon of the'igeruut
Dater
r
/b Pehm{II;Nnmher.
site ddress 0 70 . w �3f' 3
r2 l 4G_S - State,License; SLC I>icense
O ginal GC ,su -uunu,ctpr:or owner�burli er
�, ��1 >/2 ,� d State License a Q1�8'�7 *, _. SLC�Licease
d
New GC,su-b”'ontr3Gtor
Reason fbi4Qncellation
The uridersrgneil doeshereby agree to Yndemi tify and,hold harntess StLucce CiiuntX,rts officers,agents and eti�loyees frotrialt
cdstsfees or damages arising fromany and all clainis;of acronfor any.,reasoziYvhtchtnay arse:asa result ofthis chacige of
contractor/sur contra orcanGellatroi,of "
pe�imit.A perrtut Carfiot be.;can(celled zrf work I►a§been perfdrmeL
$I AT[JRE OF wNF.R( owner/6udder) Nt3TElRE CgNTRACfpR( neFit GC apPl�c-4,
f-
PRIIUT
State affionda;,GountyafSt IxcaaCQuaty Stafeo£Florida,.G'PuntyofS`f Im aCqunty
The fo Hang msttu�e was.acfCnowlgdgedsbefoie me;this wmg ofeb
;nt was acimowledged foie me ilius;
�da}�of ,20 byTc�/'1E;'; ay � ,2 y
b ,
T�i`` wlio isYemonal[.y tQiown:to me (4i /1?E°'- wha gtt rsonalty lmawn to.
or, has ptaduc 2.3"ryc�s llGx as IDrwIi- - _
' Prada as II]. t(!a
G7-1
ftf
_,...r5lgaature,ofNota °" abe; •�, �,•. �
anu.p r ,` SUSAN MON1=1dk6R0
5(JSANbtONTEPlEGRO `� �" :f,/Y'COIult49iSS10N#iGG0691199
Revised 04/151 c M�'COhiM{SSIONtFGGOB9099 IRE 21
EXPIRES Apnt 2 2021
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