HomeMy WebLinkAboutChange of ContractorPlanning & Development Services
r = ?' Building & Code Regulations Division
COUNTY 2300 Virginia Ave.
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 fled in the new contractor's
name for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: O /t 9 /21
Site Address: 3 f..0 i3c.,, f-i-, L( ., V
Permit Number:
CCcl-4 6un-.C-4-1 ..4--41!$tate License CJ(=C 16265 S License
Original General C(on-tractor (or Subcontractor)
/`l''iWLicense �i � SLC License
New General Contractor (or Subcontractor) sz,
Reason for Change
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 :7,d,.-
SIGNATURE OF OWNER (or owner/buil ) ' 1GNATURE OF EW GENES CONTRACTOR
—�-
PRINT NAME PRINTNAME , iS O {Y�C] I �� W
State of Florida. County of St. Lucie County
The following instru1ment) was acknowledged before me this
Lb�day of SQ 121►1 t' . 20 Al, by � On0.�k
ose f (O who is personally know to me
or who
nha� produced as ID.
l� �I
Signature of Notary Date
State of Florida, County of St. 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 RECEIVED
DALE S. VAN DER LUGT SEP 14 2021
lIR LS ii
Notary Public -State of Florida
_* • Commission # GG 325607 St. Lucie County
'My Commission Expires Permitting
April 18, 2023