HomeMy WebLinkAboutCHANGE OF SUB-ACPlanning & Development Services
S j`7 Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 4624578
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 ($7,500 if A/C Change -out). A recorded copy must be
submitted prior to commencing any work, Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: 1lnolzt
Site Address: 5313 South 25th St
Air Condltianing Unlimited
Original General Contractor (or Subcontractor)
Nlealr Air Conditioning
New General Contractor (or Subcontractor)
Reason for Change Poor Performance
Permit Number: 2101-0333
License CAC1818588 SLC License 20.2e038
State Llcen$e CAC041199 SLC L1CenSe 10383
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 3 a result of this change of contractor/subcontractor or cancellation of
permit. Ape it nnot b s nce ed if work has been perfo d.
SIGN OF�OnW,,NEEC (or`oAwnner/bui`ld-er) • SIGNA OF N W 'ENERAL CONTRACTOR
PRINT NAMEI, W `c. tiY `c)4�&�� FRINTNAmE PHILIP NISA A
ty
State of Florida, County of St. Lucie County
JJ & 1 t
or who hag produced ' as to.
State of Florida, County of SA Lucie Coun
*Only signature required for c of subcontractor KRISTIN BAITSHOLTS
ON MITTLER * State of Commission
# GO 27 Public
RevisedM;2=j
203869 Commission s GG 27a527
SION#GO =" �� My Commission Expires
S:June11,2022 February 19, 2023,y Underwdtets 11
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