HomeMy WebLinkAboutSubcontractor Agreement Planning&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. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: 11/10/21 Permit Number: 2101-0333
Site Address: 5313 South 25th St
Air Conditioning Uniimlied State License CACIS18588 SLC License 20-28038
Original General Contractor(or Subcontractor)
NlsalrAlrCondiUoning State License CAC041199 SLC License 10363
New General Contractor(or Subcontractor)
Reason for Change Poor Performance
i
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 an'segs a result of this change of contractor/subcontractor or cancellation of
permit. A pe it rAnnot b - nce ed if work has been perfo d.
SIGN OF OWN§ (or owner/builder) "SIGNA OFNEWfEeRALCON7RACTOR.
PRINT NANJq\ N_- YY`�� ��LJ PRINTNAmE PHILIP NISA A
State of Florida,County of St.Lucie County State ofFlorld%County of St Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
�l day of t�-� 20_4 by �— day of NOVEMBER•20 21.b PHI u
Mn"_� who is.personaliy know to me wh s penonaUy know to m
or ho hae produced as ID. or o `
Signature of Notary Date St tare ofNotary Date
*Only signature required for c of subcontractor KRISTIN BAITSHOLTS
NONM1TiLER ?_°'� `14,A_State of Florida-Notary Pubi
Revised ';b S 203868 = �•= Commission N GG 278 $
}�yCOMMI$SION#F,0 ?orM1pPA� My Commission
'•� •*° EVIp.ES:Juae11,2022 ",n++ February 19.20
Notary Vlld `� r
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