HomeMy WebLinkAboutChange of contractor (1)--- _-- Planning & Development Services
`"— - - Building & Code Regulations Division
2300 VnVnia Ave.
s Fort fierce, FL 34982
(772)462-1553 Fax 462-1579
CHANGE OF CONTRACTOR
Or Subcontractor or CaneeMatian 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 fled in the new contractor's
name fox job values greater than $2,50 ($7,500 if AIC Change -out). A recorded copy must be
submitted prior to commencing any worL Subcontractor changes can be completed by the general
contractor. Arent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: q 1 o'S� JaI
Permit Number: 5L.0 - .)�011
Site Addrcss: 9? -Lsis S. ounn 3 62 r,.._,ZS ---
G Q1. E g f , L.(_ State License
flrigiinal Gerterall Ct TAmctor (or subcontractor)
SLC .License ),133
w\�� State License SLC License
New General Contr•actar (or Subcontractor)
Reason for Change _P Ev - _ a�S -
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
agents, and employees from all costs, fees, or damages arising from any and all claims of action for
any rein, which may arise .as a result of this change of coma actorlsubcontractor or cancellation of
perrnnit, A permit coot be eau` celled N work has been performed.
A /Lo�
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51UNATURE OF OWNER (or ovmerlbuildecr) # SIC>I+IATLiRF O7 �w � CONTRAC OR
&M of Flrrrida, County of St i ucie Cowaty
The Mowing incixumocra was adnovrledged before me this
N%�fil Sv 1 ✓ .1. �s personally k.. to me
hare.#' .tsry Date
Stak of ylaric* Canty of 5t. Lucie Cocmty
Ti3c following instmz=nt was acknoweciged before me this
— day %�? r? _Z2, by c Z1 r �
who is pmonally 3arow to roe
rxr �vho has as ID.
�p s
Signature of Notary Date
*Only signatur ze ed for change of subcontractor
Revised 07421114
;. FRANCE$ CANCEL
5«• «g MYCQMMMS101 GG318353
EVIRES: August 1. 2423
.... ,Ps FLU•` Bonded Tku Notary Pdk Undemllten
s►0 �''�_ SHEI AAh GARREFFA
Y Public -State d Fla ft
' Ctrtrssian AHN 73293
?Ffa,• My Cam- Expim Dec 17, 2024
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