HomeMy WebLinkAboutCOCPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)4624553 Fax 4624578
CHANGE O� CONTII��:"I,(D11�
OI Subcontractor or c�anMvliation oV��li 11ut
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:
Permit Number: SLC. - p44 Z
X44�7m Cain i t
`n(1 State License . j S 2S•7 S'>LC License
Original General Contractor (or Subcontractor)
New General
Contractor (or Subcontractor)
Reason for Change
tccrS�)sGVz.
,S
State License SLC License
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/ I ,
SIGNATURE OF OWNER (or owner/builder)
W0,111H
`Ilijilui�l
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 120 by
who is personally know to me
or who has produced as ID.
Signature of Notary Date
*Only signature required for change of
Revised 07/Z1/14
State of Florida, County of St. Lucie County
The following instrument was acknowledged before cue this
`day of (iG'}_ , 20 21 , by Z
who i rsonally know me
or who is duced as
Sign e o aiy Date
subcontrac AMANDA ODATO
g, NOTARY PUBLIC
o STATE OF FLORIDA
Comm# GG346668
iN E I Expires 6/19/2023
E�
City of Port St. Lucie Building Department
121 SW Port St. Lucie Blvd
Port St, Lucie, FL 34984
772-871-5132 • Web Site
PERMIT if 2oos-0742
www.cityofpsl,comlbuildinq
Change of
Contractor
PROPERTY ADDRESS: Mile Marker, 144 Florida's Turnpike, Port St. Lucie, FL 34984
LEGAL DESCRIPTION:
SECTION
BLOCK
LOT
Parcel ID#
OWNER INFORMATION
NAME
a j� , ,
PHONE# 5612755671
MAILING ADDRESS
ZI I L cvice rs 5 urn
lug � �- s �e a [ h(0s8e. 3
CONTRACTOR INFORMATION
NEW CONTRACTOR NEELZ LLC
QUALIFIER'S NAME RYAN NEHLS
MAILING ADDRESS 405 E WHITNEY DR JUPITER FL
33458 PHONE# 5612755671
EMAILADDRESS RYAN@NEELZCO.COM
PSLCOMP #
STATE LIC. # CGC1525985
PREVIOUS CONTRACTOR EASTERN CUSTOMS
QUALIFIER'S NAME SAM LEWAND
REASON FOR CHANGE OF CONTRACTOR: O Non-performance of
contract O Contract disputes to& Abandonment of contract
O Contractor is deceased
i
<) the
owner, acknowledge that the previous contractor was will be removed
from the p rmit listed above. I shall assume full responsibility for
the work completed by the previous contractor and hold the City of
Port St. Lucie, its officers, agents, and employees, including but
not limited to Building Official(s), harmless and without any liability for
the removal of my previous contractor and any work performed before, during or after such removal. I understand that a Change of
Contractor f e will apply for this change if the permit has already been issued, and that any sub -permits which may exist at this time
must be pplied for inZ4r to ove forward. Additionally, anew Notice of Commencement will be required per F.S. 713.13.5(a).
A
New-C r c r Signature Date
Owner Signature Date
Print Narr}e
Print Name
NOT U S • to of Florida
NOTARY PUBLIC, State of Florida
,
STATE OF FLORI A,
STATE OF FLORIDA,
COUNTY OF YALM
COUNTY OF
[NOTARIAL SEAL]
[NOTARIAL SEAL]
The foregoing instrument was acknowledged before me by means
The foregoing instrument was acknowledged before me by means
of O physical presence or D online notarization this day of
of D physical presence or D online notarization this day of
0 Cr 20.11, by \ who is
20_, by who is
per erratl�ylcaewa�te o pr duced
personally known to me or has produced
as�tro�
as identification,
y AMANDA ODATO
dot
Q NOTARY PUBLIC
-+5 i H i t ur rwrcwH Comm#GG346668
a
E 19�� Expires 6119/2023