HomeMy WebLinkAboutCHANGE OF SUB-ACPlanning & Development Services
S ] 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 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: 11111121
Site Address: 2205 Rlverhammock Ln
Permit Number' 2108-0161
Alr Condltloning Unlimited State LiCenSe CAC1818588 SLC License 20-2ao38
Original General Contractor (or Subcontractor)
Nis* Air
Condltloning State License cACoallee or License 10863
New General Contractor (or Subcontractor)
Reason for Change Poor Pertormence
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 resul f this change of contractor/subcontractor or cancellation of
permit. A permiZeminnot, nea work has been perfor d.
SIGNATUROOF OWNER (or o er/builder) 'SIGNATURE OF NE GENERAL CONTRACTOR
PRINT
State of Florida, County of St, fArcia Comty
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PHILIP NISA JR
State of Florida, County of St. Lucie County
*Only signature required for change of subcontractor
Revis QTd,',21td4 SHANNONMITTLER
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EXPIRES: June 11,2022
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KRISTIN BAITSHOLTS