HomeMy WebLinkAboutChange of Contractor RECEIVED
�. Plu>tming&De;yelopm`ent Services. MAR 18 2020
Bnildtug.&Code;'Regiilations Diff9ion ST. Lucie County, Permitting
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Oki-8,ii-4oikttractoir oir CanceXlla't_iior►::of,Permit
Gharige of Conri acOr is:t6 bc.coirij�leted by the propei ty.ownet,Find the neiN-contractor.of ieco d to `tlie
cuirent,pel niit A neW permt application-must:8lso.be•comol&ed With new. 'contractor information;.
signature, and lransfei fee..A neSv l oth a of CoitimenceliWfiit hifist j e.fil'd.tii tlic flow contractoi S
natue:fo> aob values gi eater than:;62,50Q;(�7,5011 tf AJC Cluange out): A.1 ecoi decl copy vuust be
sitbtnitted prior`to,cotriineiicitig,aiiy�yoi�lt, Subconttactor Izhanges can`e. -completed'by,ahe:general
contractor Absent extenuating circtunstances;.a-canpd11at_ipn of'.perinit-is to be executeii,by bout-the
owueT:and tjuahfiel of tecot•d.�
' . 3 16'2026 i ;
Drite:' :.:-.. -_. PermYf)`1i>iib';er . Qf
Alr Electric StAte-Liddnse: :SLC Licerisc
Oi'igliial General Contractor(or
Elecfrlc_, Connection State:I:ice>ise r Co 0o Zq3$SLC L iccnse
`.Neiv General Contractor.(or Spbcolitractor.-) I
Reason fbr;Cliange Arigitial_trade wlll n6l..compieteNotii I
The undersigned:does iiereby,agree to indemnify and:hol8 haiYifiess St.Lucie'County,its'officeas,
agenfs,,and employees fiorrr all costs;fees,_or damages ai7sing from any and ally claims of:action for`
.any,reason,.whichinay a>ise as a.result.of tli s.change of coittlactoi/subcontractor or cancellatiori.of
permit. A pertmlt t.an titE he cancelled if ivorlc has been.p-ei formed: I�
:SIGDIAI - .FO} _ R.(orolvner/builder) w`SIt3NAT(IREOENE\V .•_--_ -_.AfTiCACTOR 1 j
PRINT NA.IC Kevin BUrICGlltha PRII9TNA��iE
stale ofElandn,County or$t.Luca County :$fate of Floifdar Coudty ofs,Ll ie County i
The folloi�ng msttnmcnt was ad}noWlcJged before nio-this The:foll6withg insthm6ft was ncldioivled'' Ucforo the lhrs
16th March ..zs. n
day of 2tj_,6y day of l f^ 20 by J
Kevin,Borkenfiageb iv,--is-peis6- ly know fo me :.hf:is`ifecsonally know tvmd.
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Or wlio ti roilucat as- aced
Signn urcofNotaijr piitc SigootweurNotary Data C,gpiUtY?p _•
3 :16fii _ rib
*Only, signature -required for chatTge,:of• subcontractor
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�,r,,�, itonrt:tvrtzrll a o ffGG 272984
Revised 67/21/19 i?°e a � 1c•SlateafFlcrlda i •'.a 6 0�:' Q
,a ' Ccauulssleri9.GG9t767i 9 •.�10 ndedth�J
wn.°'� "ICnmC.trpfre1
.5_ 29,2021 j�{ '•�blic lJnaO�
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