HomeMy WebLinkAboutSub-contractor changePlanning & Development Services
Building & Code Regulations Division
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 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. Abscnt extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date:'
Permit Number: DO V - 00'A
Site Address: SRO 5"67 t/i1/r�A
L11f,M¢ j S" / State Licens,5Z �,F� Z_ SLC License 3r 93Z-
original �Jencral Contractor (or Subcontractor)
C, MOoi e EUc'C State License E 3o0U1111- SLC License .910 q%
New 13cricral Contractor (or Subcontractor)
Rcason for Change Cct/?t M /1 or _G_OM�«7� p/ZoJ _ 7— __O_/Y
The undersigned does hereby agree to indemnify and hold harmles St. Lucie County, its offic 'rs,
agents, and employees from all costs, fees, or damages arising frorr any and all claims of action for
any reason, which may arise as a result of this change of contractor subcontractor or cancellation f
perfniit. A permit ca t e�¢lancelle'd if work has been performed.
r ��
` 3fGNAT R OF
R �'iT NAME CL (
e—� PRfPdT NA P.�G
State of Florida, County f S1. Lucie County
State of Florida, Ci
The following instrument was acknowledged before me this
2/�I,"%d ynofylt,�iA fxr . 20 21, by S
the following insti
/ day o f
L (ilXnnN �1 rr i�i who i crsonally know to me
or who h�c'prnrh ed _ n / Gt - as IT)
or who has oroduci
Signaturkad Notary Date Signature of Nod
*Only signature required for change of subcontractor
Revised 07/97 / < < JESSICAWHELCHEL
,P•'�:
MY COMMISSION # HH 149774
rP EXPIRES: July 7, 2025
FoF F ° Bonded Thru Notary Public Underwriters
:on
CONTRACTOR
of St. Lucie County
was acknowledged before me this
ste.,202%,by 67 / /na�C
who is personally know to me
Date
M
ao�aays Susan C Vogt
r g NOTARY PUBLIC
=STATE OF FLORIDA
Comm# GG 154701
s�NCE ta�0 Expires 10/2712021