HomeMy WebLinkAboutchange of contractor TKO Signeda aaunsu� •s ascramiauacns aaa.a torso
Building & Code Regulations Division
2300 S'iMINUf AVe,
Fort Pierce. FL 349112
J77214624553 1" 4624518
Ci-1 ANGE 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 flied in the new contractor's
name for job values greeter than $2" (S7,500 if A/C Chang"utL A recorded ropy must be
submitted prior to commencing :any work. Subcontractor changes can be completed by the general
;mntractor. :absent extenuating circumstances, a cancellation of permit is to be executed by both the
v6Ewer and qualifier of record.
Date: L 1 G G- r z D
Site .Address.
Permit number: 2003-0366
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:Qlir`t.A.d/t_ State Lieens4e � Q 7 rW Sit' License____
-Original [ encral Contractor t cn Subeuntrayctor)
\ �d K. K& State LircttseCFC1L1Z25aLCLicense
ltiew tdenrtal contractor 401, Subs floors \ �.%
Reason for Change _A�-/� !(`,(�
The undersigned does hereby agree to inden ni4, and hold harmle&g St_ Lucie County. its officers.
agents, and enmplo)ees froin 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.'subcontracter or cancellation o
+T ti` °*" a*pennit. ermit cannot he cancelled if work has been performed.
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FLORIDA INDIVIDUAL ACKNOWLEDGMENT
F.S. 117.0503) — Effective January 1, 2020
�JAt
State of Florida
County of 5
yx# _♦ta;�aV�x: z_= CORrtOtisSsiEsLs'Yi0NnF+:RIMPONG
Notary Pu0lic-StaeofFlorida
GG 133742
rs 1My COtiN WeAug 3,2027
Place Notary Sea/ Stamp Above
The foregoing instrument was acknowledged before
me by means of
P < al Presence,
—OR—
❑Online Notarizati&—,
this day of 2� by
Date
Month Year
Name of Person Acknowledging
of NotGY5'Public— State of Florida
of Notary Typed, Printed or
D Person nown
oduced Identification
Type of Identification Produced:—
&V
OPTIONAL.
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document,
Description of Attached Document
1 iile or Type of Document: V,�/
DOCLIment Date: _ I I —
Number of Pages:
Sidrler(s) Other Than Named Above: J1i-
'W2019 rvationor Notary Associationmom i"
M1304-11 (01/20)