HomeMy WebLinkAboutChange of Contractor-Planning & Development Services ,
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
MAY 1 1 2MIS
Public Vf-,,._
St. Lucie C:uly: _,, d::I_
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 Change -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: 5/11/16
Permit Number: _ 1 j 12-. — 04-11
Site Address: 31 U N W L-Oct l� W
Richard Manning Woodley
Original General Contractor (or Subcontractor) State License ------CBC97o SLC License
Scott Harala
_
New General Contractor (or Subcontractor) State License CGC1506052 SLC License
Reason- for Change Richard Woodley left company
'fbeunde
rsigne- hoes hereby agree to mdemmf and hold harmless St. Lucie County, its officers,
from all costs, fees, or damages arising from any and all claims of action for
agents, and employees
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.
5614
SIGNATURE OF OWNER (or owner wilder) * SIGNATURE OF NEW GENERAL CONTRACTOR
PRINT NAME s CC WALC_ PRINT NAME SCOtt Harala
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
' S dayof May 20?s b
, Y
Scott Harala who is personally know to me
or who has p e
mission # FF 14 07
'.� Ex ovember 8
Signature of a°- Pyg�
Bonded Thru roy Fain Insurance 800-305-7019
*Only signature required for change of
Revised 07/21/14
State of Florida, County of St; Lucie County
The following instrument was acknowledged before me this
day of May 20- 1a. by
Scott Haralpersonallyknow to me
or who has produc
�` "•"•° "' I ENISE BROWN
Signature of Nota =hi )t '' 0nlmission # FF 140607
=� Les November 4, 2018
Bonded Thru T
subcontractor roy Fain Insurance 800-385-7019
x'"
SUPPLEMENTAL CONSTRUCTI"ON LfEN LAW INFORMATION: -.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:'
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with,your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
S!p� -
Signature of Owner/ Agent/ Lessee Signature of Contrac or License Holder
STATE OF FLORIDA
COUNTY OF Broward
The forgoing instrument was acknowledged before me
this 5 day of May 20" by
Scott Harala
(Name of person acknowledging
(Signature of Notary Public- State of Florida )
Personally Known X. OR Pro SgOAe>t
Type of Identification P U&e ,,, SE BROWN
=2 cw=_ Commission
tuber 4, 2018
Commission No. '-�•.��? Ex itgl�'Aelp
F.�.�`� Bonded inNToy Bin Insurance 800305d019
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF Broward
The forgoing instrument was acknowledged before me
this 5 day of May , 2017-1by
Scott Harala
(Name of person acknowledgin )
(Signature of Notary blic- State of Florida )
Personally Known x _ OR Produced Identification
Type of Identification Produced
Commission No. A.RNR, DENISE BROWal)
■: s.= Uommission # FF 140607
Expires November4, 2018
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