HomeMy WebLinkAboutChange of contractor Oct. 15. 2020 3:56PM No. 4867 P. 1
Planning,Srr Development Services (4
l - Building& Code Regulations Division
NTY 2300 Virginia Are.
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 Cbange-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: d `"1_ Permit Number: nQ
Site Address: 01 Q
CM
State License l` � SLC License
Original Eral Contractor(or Subcontractor)
State License SLC License �c
New General 06ntrac?r(or Subcontractor)
Reason for Change US w
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/subcontractor or cellation of
permit. A permit cannot be cancelled if work has been performed.
TLTRE VVN13It (or ov er/buildc) f *SIGN T Mw NERAL CO{N�TRA f
PRINT NAME t o l PRINT NAME
State of Florida,County of St.Ludt Comity State of Florida,County of SL Lucie County
The following instrument was aolaiowled ed before me this t The following instrument was a0mowledged before me this
M1dayof bZ 2Q b jSlk day of ,20:�Db
who is ersonally kno me me
Mho has produced as ID. who her produced as ID.
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Signature of Notary Date Signature of Notary bate
*Only signature required for change of subcontractor
RevJ,sed 07 Ld pANIELLF,GONCALVES
2 MY COMMISSION#dG 232946 <_!W DANIELLE GONCALUES
Cbt EXPIRES:June 27,2022 ' MYCOMMISSIO
Bonded Thro Notary PuhficUndsrvfilere %aQ�o, EXPIRES.June Z7,2022
pOFd;° Bonded TtuUNolorypublIoUndenwdtets