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Building & Code Regulations Division
2300 Virginia Ave.
M01111. 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 ($7,500 if A/C Change -out). A recorded copy must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: — 0 r c7
Site Address:
Permit Number: sLC ate- s sf
C5 C.
(4q
State LicenseD�� SLC License
Original General Contractor (or Subcontractor)
New General Contr
Reason for Change
State License
SLC License
The undersigned doeereby agree to indemnify and hold harmless St. Lucie County, its officers,
agents, and emplo from all costs, fees, or damages arising from any and all claims of action for
any reason, whi ay arise as a result of this change of contractor/subcontractor or cancellation of
permit. r it nn(
be cancelled if work has been performed.
NAME
State of Florida, County of St. Lucie County
11 • SIGNATURE OF NEW
"' r— PRINT
The following insTtru/m'e t was ackno ledged before me this ( QJ1Rie`�II�jlrk'tTi�l
day of c� "t 20�by 4�a!?`�t•'•;COmm NAge Vol,$a�
�aslD.
' r�TE.
or4v has poduced / who has produced
,�I,"Wv `ture of Notary
*Only signature required for change of subcontractor
Revised 07/21/14
of
IERAL CONTRACTOR
County
cKowledged before me this
20_, by
who is personally know to me
as ID.
Date