HomeMy WebLinkAboutChange of Contractor�S_ State License
New General Contractor (or Subconn6 t rc o )
_ _ Planning & Development Services
! ' Building & Code Regulations Division
® 2300 Virginia Ave.
Fort Pierce, FL 34982
77 - 55 Fax - 57
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: oZ a 2
Permit Number: 0//- b `5/6//
Site Address: -3 [ i d Su 'S
/'lP � o Gil ,�' 6 yi G State License El 130 Q;, �%?SLC License
Original General Contractor (or Subcontractor)
SLC License
Reason for Change �na& le-_
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.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE OF NEW GENERAL CONTRACTOR
PRINT NAME PRINT NAME
State of Florida, County of St- Lucie County
The following instrument was acknowledged before me this
/3day of 20X,by
who is personally know to me
or who hr
as nr uced v as 113.
Signature of Notary /Date
State of Florida, County of SL Lucie County
The following instrument was acknowledged before me this
day of 20_, by
who is personally know to me
or who has produced as ID.
Signature of Notary Date
*Only signature required for change of subcontractor
Revised 07/21/14
HEATHER BURFORD
State of Florida -Notary Public
9 0` Commission # GG 183 e
My Commi17
ssion Expires
��'�;°;;;��` February 06, 2022
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division REcEMD
BUILDING PERMIT MAY 1 ? 2021
SUB -CONTRACTOR AGREEMENT
Permitting Department
St. Lucle County
have agreed to be
(Company Nam eiIndividual➢flame)' ,
the%l1J�c Sub -contractor for
f Trade) f�,,� (Primary actor)
(Type o
J
—�
For the project located at 3� C7 1 ,� / %/ i�k'fze, 1
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
CO O ATURE (Qualifier)
PRINT N
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this �i, i day of
20 i byy tti.. E2
who is personally anan known or has produced a
as weatincapon.
i
Signs o o Public
Print Name of Notary Public
AN
BRENDAROMEROZELAYA
`F'? Nctary Public - SWe of 00%A
Co issicGG Z0511Z
Expires Apr 15. 2022
{mOeC :rreur yrnnrl NstifY W.
Rev
J
/d/v& �'J14i�L
S CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
.�_ci -3 �51-
COUNTY CERTIFICATION NUMSEjt
State of Florida, County of_ j4 C
The foreEffing instrument war, sign before me this of
20�,fliy t 6
who is personally !mown _or has produced a
as identification.
STAMP 4xt"�. -STAMP.
Signature 6f Notary Public
Pont Name of Notary Pub
118LAUDETTE D. PA EN
tPR O� NOTARY PUBLIC
a STATE OF FLORIDA
;�^" a Cahn# GG298272
MCE 19b0 Expires 2/412023