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Tl: Building.4z;Code Regulat olxs pivision
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o _ tii'tPltjt'se TL 34982
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CHA.NGE:OF CONTRACTOR
Or Subcoritractr or:C_ance�lation of Permit:
-Change-of C6Atlactox_:is fo.be complete�l.by the prb. ..t:owriet;'and the new contractor of record for-the
curf6ht pe>,mit: A ow perintt applicafion,must'also`be completed with new conttactoi tnfofrtiatiori,
signature,andtrarisfei;fee. A.new K006 o Gom;ne►icement must be filed in fie new contractor's
uante for�otS values greater than $2,50d (`7,500 if A7C Change:-.out). A recorded.copy#iust.Te
submitted pit.ior to coinirlendii airy worl't Subcontractor Changes can.be-completed'�by the.general
contlacfor. :AUsent extenuating ciretunstances;_a:cancellation:of'pei7nit is to be.executed by botli the
owner and qualifter-tif ecdrd,
Date:, ;a-1s=2o2o =Permit-Number: �/,#a n(W
Site.:A ddress:.
Sir Electric Sttite IicenseLG License
OriginsiI'Gencraf Contractor(or-S gontragtor)
Electric Corineolian � •
�StateiLicense.�C�o 2Q3� �SLC License
Naw=General..Contract'or.(oi•'Stilicontractoi.)
Reason for'Change Originalara le*111*t:COI0.1et irk.
The.undersigned.does her eliy agree to tndeiririify and Fiold_harmless'St,Liicte County;its.offcep,.
:agents;;ttrid ern loyees fronl;l ll costs;fees,:or damages arising from.any and all:claims of action.for
any'>ea son;wli ch may arise as a result,.of this change of.contractor,.40cc lurid..WCor cancellation of
� pe•int: �,:pc;;�mit_ca�n t-)ie canceller if°.worlc hus,been.,perforuied:
SIGNATUAE 0WN (or_ovWgn6uil6r). t.SrarrATU EDFNE� OE vAL..GNTRA"CTOR
•PR3Nx Nt1Mviz Iiorlcenha�;en PR>N_Trtutis
-StSte of Florid5;Comity of St:l:ucia County Stale of Florida,County if St:Gucio:Counlji`
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' 7K1ecyionl loBlvyoorrkgeinndhrage_n' 2ry0 bdis jrcirsonally;kiioiy lo'nio: ll''.��t,��-fit►�s ackhnmvplcedrgsco nnblelyfMpro ni wet othis
twbe eov »
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16th of March by 11.dayof 2oa by l
lvaisR :
tne,
at Alm has procfirbetl aslD. Tham{�uccdpas ID
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Slgn fNoiary, 'Dale yj SignahrrcoFNotary. 1)ato \����ppG.��t-GWTjy/Yj,l
`C;•��laSSIONA 1'��i
*onl;y signature required for ctiarige o sTi$contracGor ;w ROPRY?o
Revise$ 014-4/14 r; TloWrypuLBc-Sraica6 Ft.rldg *� ®a®
�,t taimelutanl GC 91T61 f' =y:y tree 272984
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