HomeMy WebLinkAboutChange of Contractor '0b10
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't Planning_&Deyelopmcnt Set vices
dfil _kc-4e•.Regulatioits;Di.vision MAR � � `l_0?�u`
230;0 Vitgiiiia.Ayc.,
r :Farf Mfee,FLA082 ST. Lucie County, Permitting
CHANGEOF O .-CONTRA CTOR
cntactgr orCnei #ionof PermitOrSubo •
Change.of 0optrdvtgvis to:be colnpletcd by the propertyoVvner,1ua the new contractor of lecord:fer the
.current permit, A new perlruf applicatioti must,also Ei_e�completed with new'contractor ilifoti ration,
sigiiatt e,and trausfe> fee. A ne`v Notice.of Cotpmencement:must he iled.in.the new contractor°s
name,tot fob.values.greater-than V 500`($�,50.0 if AJC Change out): t� a-ecotded copy must be
submitted.rior to.commeiiicing:any W 'ticontactor changes.ctn ve completed by the genet4T
contractor Absent:extenuating circumstances, a cancellation;of permit is to be:executed by b th':the
owner'ad qualif ex•of record,
Date;: :3=16 2020 Permit Number:. l012-60ft
Site;Address;; S�� ,�tMlN� �1 '
Sir Electric: Stato Lie_dwe• S> C_'Licepse i
Original--General CoAttiiceoc.(or sulicogtrncfor)-
E_ect 1
I
:!..-... . - t .. — State license Cr C oeo 2q 3 9 'SL01icense
ric Cnniieclion:
. . I
New;Genei'atContm6to-::(oi'Sirbcdntiactor)
Reason fa}Change Original trade-will.0#o`coril081:6 work
The utidels giied does:hereby agree;to mdemn>fy and holdhaimless St iucte Qo'g ty,its officers,
agents,and employees.fiom:all costs;fees,.o>:.damages.ariiing.from any and°all claims:of..action for: i
.any I`casoii,wluch;iiiay ali5e'as a:result of this change of:contractor/sitUcbiltract9i';or cancellation of
perinii..•A permit cannot cancelled if worklias be"n pei�fofined.
SIGNAT011 OF- (oi.otvitailbWIdd) *SIG1V/CTDRE OF.NEW 13 ON'I-RACTOR
PR3NT'NnM even Borkenhagen;
$Ialc oMgti o;C6mity OSt:-Lucie Coady sl'ula orF166.County of st:.Ludic Courq
Tltc rollotwng kistztimCnt iFas icididwiedged bcfprc liid ibis Tjsefollowing instrutndnt-wa3 acknowipad,cAbcrorcme lhis.
1 Mach z IdyorlWW daya � 0M by I CLU 1LU.>n
,Kevhbbrkenhagen is perspii6llq.knout 1p,mg - dl T a— tyho_is uctsonally now toln;e
or\Ylm fins hnsduced - ssln. OC1Y o }tccd Ss ID: 'vW1111H1!///'O
75"
Signature ofNolitty bate. Siguphgco[Notory. Ilutc o4 RIOI���Qy��
;•���� ?°20`�
*Only signature required for diiari ' f subcontractor = :
Revised 07/Pl/19 ii "` NotnryPuUllt Stale of rlodda Z O o RGG272984If
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