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r Building S Code Regulati9ns:7t)ivlsi60
23110 Virginity Ava.
Port Pierce, Ft. 3d902
(772)162.1553 Fes aG2-t-"R
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Peri it
^ nS"c'bG otrirnctor is to be completed by the property owner, and the new contta.dOr t'+t,;=.morel fm 111e
ant,• terinit. Anew permit application must also be Completed witli aew, (;orxtraGlOr-inforas.ut-'or'-
�� t0'h1re, end transfer fee. A new Notice of Commencement must he filed in the new contractor's
ire 'f}ir job values greater than $2,500 ($7,500 if A/C Change -out). A recorded ro ry roost be
�'Itittit�i (firior to commencing any work. Subcontractor changes car he conjoleted by tktc general
a;'. ith"Artor.:� Absent extenuating circumstances, a cancellation of ,perinit is to be execmed by both thc.
,,;t„i;�� ' bW48Y• ndqualifier of record.
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Sate: PertnitNumber: -
Site Address- S( 441 u.n.1
1'0��?� �. �I S�Gm 5 State Lir cnsc CCC 333r7'18g g}„{: License
Original General ntractor (or Subcontractor) _--
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�egf� OFevue. �.l5 titt5 irt2illltlZti'(estt oe tales u « a: G'C 133 ?.34L- SW LiiuYlie _ _
- Neyv'Gencral, tractor(orSubconn'actor). /�1--
Reason fbi ChangeULs'f tse- rYta6Qt--
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undersigned does hereby agree to indemnify and hold Karol y t fftccrti,
ants, and employees from all eas s, ices or damages arastng% ctatiaas czf action for
j reason. wlu h may arise as a result of thus rliange of conruaqw—
A peen 't cannnt he cancelled tt work'bas been performed. i
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S1Cl!r�"i IIAE. OF i)1C'hIRP. for atone, onildt y�
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