HomeMy WebLinkAboutChange of Contractor Oct. 9. 2020 11 ;47AM No. 4850 P. 1
Planning&Development Services
i.., 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: l permit Number:
Site Address: /3--?Y NW Zfi4X"a I&rwe daf/� G/6
ezj State LicenseLG y YZ SLC License
Origins neral Contractor(or Subcontractor)
State Lieend_Q..5/7 51� SLC License
Nero'Gen�ral 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/subco tractor or c cellation of
permit A permit cannot b7calcelled7if work has been performed.
SIGN 0 OWNER (or o�/bd der) "SIGNATCJ1tL OV N)?QV GPNI?RAY Cr(ek
TCTOR
PRINT NAMIJ /�9 PRNTNAML Wl i G
State of Florida,County of St.Lucio County State of Florida,County of St.Lucie County
The following insWument was acknowledged before me this The fo]owing i nument was acknowledged before me this
day f�O 2021?by iI1 y of 2t by
who is personally know to me who is5M��E�
me
ho has produced as ID. o o has produced .
signature of Notary Date Signature of Nomry Date 2ra
*Only signature required for change of subcontrae'Cor
Revised 07/21/14