HomeMy WebLinkAboutChange of ContractorPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Foil Pierce, FL 34982
(772)462-1553 Fax 462-1579
CHANGE OF f 9NTx) G+GR
Subcontract r
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.. 's
name f doh r as gre^* r ikiiH-gj,-nn re7 -nn .f , rr ��,., ., „p - +e tie
s . 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: 'A&Z Permit Number:
Site Address: zw'e4 it 'e'� /�SZ 1154, � �7
[il t'�t�viY _State Licensee SLC License ZIolcq
License�,jgZ903RC License zg21 O
New
Reason for Change
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 cancellation of
permit. A permit cannot be cancelled If work has been performed.
SIG: "a RE OF OA `ER or oaver'bui/der) + SIGNATURE OF NEW V6� --+9R-
PP.INT i7PM.E � � PP--,TTNANE
State of florid. Cmmry of St facie Camt, State of Ficnda, County of St Ume Cotm',
Th�e� f'o�t1loaing =W=em ams acknoMedgedd bbeibrre me this The foRmW insvumettl aas admoniedged before the this w
i j�i . '��-Y of , %1 . be �' t7-}��ldar� of �ACJ( J/ 1 , ��, hyx5'� )+ - r
,IiC.[_Ji%S alto is ixtsonant know to me a t �J aim is personailvG Iron to me
or alto has produced as ID. nho has produced as ID.
1 3ju/aI AC&.Q
Signatatrof\otary Date SignatumdNotsrY Data
*Only signature required fox change of subcontractor lAC
NiCOIe
Revised _.l 4 z
coopMai.t1,201=