HomeMy WebLinkAboutChange of contractor formRevised 07/21/14
Planning & Development Services
Building & Code Regulations Division
' 1 ]7r
2300 Virginia Ave,
1 L �2 L i Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
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:
Site Address: 76r n
Permit Number: ��� ( 6- y
�- Fo%f % rP cos,
State License SLC License
Original General Contras (or Subcontractor)
11 zo ��n S��i����C�GI Sn.�d: Crr C ��State Licenser C l ��z�
! C .0 SLC Lirt:rtce.
New General Contractor (or Subcontractor)
Reason for Change
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The undersigned does hereby agree to indemnifv 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._ A -
SIGNATURE OWNER (or owner/builder)
PRINT NAME�rG �'"v
State of Florida, County of St. Lucie County
the toIlowing ment was acknowledged before me this The following instrument acknowledged before me this
day 200 �+, by ZJ day of 20� , by
who is personally know to me who i nnally kna tome
or w s e [7 or who pr
Signature of Notary Da Signature of Notary Date
*Only signature required for change of subcontractor
t R PATTI A. MAM%0 iPvl-u R
Notary public
State of Florida
r Comm# HM58828
Explre57/29/2025
State of Florida, County of St. Lucie County