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HomeMy WebLinkAboutChange of ContractorMot o Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982 (772)462-1553 Fax 462-1578 CHANGE OF CONTRACTOR 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 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to commencing any work. Subcontractor changes can be completed by the general contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the owner and qualifier of record. Date: 3-Z ) — ) u ' p� Permit Number: /_/I�� � / ' Dbz Site Address: 442DO ' !i Y 7-�� !/l 5}c, CGS S-4=,J[ a,6 +p11 tP J� a2,40 4, State License 66.1?;!�5 3gLoC License Original General Contractor (or Subcontractor) E_Cf,3oo2gs � State License SLC License-366_3 New General Contractor (or Subcontractor) Reason for Change The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers, agents, and employees from all costs, fees, or damages arising from any and all claims of action for any reason, which may arise as a result of this change of contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has be L C SIGNATURE OF OWNER (or owner /ijd�er) PRINT NAME dA„'l)n L4AV State of Florida, County of St. Lucie County The following instrument as acknowledged before me this -` Iday of A 20 �, by c�v..vTg who is e or who has procipced as ID. Crum. Mne,,._ Signature of Notary Date :5 —Z State of Florida, County of St. Lucie County The 11©gwing instrument s acknowl Red before me this day oft a 20,- Dl , VVS&L JLj who is personall ow to me or who has produced as ID. �A$ro Signature of Notary Date *Only signature required for change of subcontractor Revised 07/2 ��• s CRYSTAL DAWN MOORE MY COMMISSION # GG066605 -11 •� EXPIRES January 26. 2021 oVIALOMWDOIDOMMISSION 0 FF 02MRES: February 22, 2020 Tnm Nouul'Fu66tUndemrDrs r,,ri' S 9 57LJG)C . [if