HomeMy WebLinkAboutCHANGE OF CONTRACTOR FORMThe „fillowing i trument was acknowledge bef m this The fo owing ins/�ment was acknowledged before me this -.
�Vt7 day of r 201a by I ay of 202�1 by"yknow
who is personally know toor was produced f t��as I*Only signature required for change of subcontractor
Signature of Notary
Date
Revised 07/21/14oPRYPUB,Prira'95BW81COft
Commission # HH 4385t
<Commission Expires 09-23-2024
�'FoF�oPBonded Through -Cynanotary
Florida -Notary Public
Planning & Development Services
- ` J ' ' = Building & Code Regulations Division
f 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: 11-17-2021
Site Address: 7159 S US 1, Port St Lucie, FL
INNOVATIONS
Original General Contractor (or Subcontractor)
SUPREME BUILDERS GROUP, LLC
New General Contractor (or Subcontractor)
Reason for Change
Permit Number: 2002-0505
State License
SLC License
State License CGC1529119 SLC License
tS\1.1
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 ma arise as a result of this change of contractor/subcontractor or cancellation of
permit. A pe an t b if work has been perform
SIGNATURE OF OWNER (or owner/builder)
PRINT NAMEGtC�
State of Florida, County of St. Lucie County
State of Florida, County of St. Lucie County
who is peme
or who as produced as ID. ii
�t yv � F •i
Signature of Notary Date �—\
o PP PUB, Primrose Walcott
� Commission # HH 43851
Commission Expires 09-23-2024
Bonded Through-Cynanotary
Florida -Notary Public