HomeMy WebLinkAboutChange of ContractorPlanning & Development Services
_ = Building & Code Regulations Division
COUNTY 2300 Virginia Ave.
• I . 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. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: !L ' `�- ? /
Site Address:"410OCk;7
Permit Number:,- 1 0 -7- 00 2 T
0,6c t i 3851
State License SLC License
Original General Contractor (or Subcontractor)
(3eZ.aa1 kS4ce,; t S � 'kylg., e License G(SLLC License
New Qfndrdl Contractor (or Subcontractor) C �l/- C8133
6,0
�,(i'. Reason for Change N
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
ag9d6>Qd employees from all costs, fees, or damages arising from any and all claims of action for
reaso which may arise as a result of this change of contractor/subcontractor or cancellation of
petmit. A pe mit cannot be cancelled if work has been performed.
(or owl er/Uuilder.) `'--��SI ATURE OF WTV GENE/AL CONTRACTOR
IQ it INTNAME� /t/ L e al
State2fFrorida, County of St. Lucie County
The following instrument was acknowledged before me this
day of IeIY&r 20g by
who is personally knowdo me
or who as roducc as lD.
I�
Signature of tary Date
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
1 kP dayof 205a by
L CamO-who is personally know to me
or ho has pro cd Oias 1D.
1
Signature of otary Date
*Only signature required for change of subcontractor
Revised 07/21/14 MELISSASUAREZ
MY COMMISSION # GG 272199
=mom r`,•= EXPIRES: February 8, 2023 7.
"QUF Fti�.` Bonded ihni Notary Publ[c Underwdlers
Y MELISSASUAREZ
MY COMMISSION # GG 272199
ao EXPIRES: February 8, 2023
'•.�odF °•` BonmThNNotatypubllcunderwifters