HomeMy WebLinkAboutchange of contractor (3)Planning & Development Services
- _ .d' Building & Code Regulations Division
COUNTY 2300 Virginia Ave.
+ R I D A 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 ($7,500 if A/C Change -out). A recorded copy must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: 12.23.2021
Site Address: 3902 Dunesdie Drive
Micheal Kevin Waish Roofing
Original General Contractor (or Subcontractor)
Permit Number: 2110-0115
State License SLC License 29147
Sunshine Roofing State License SLC License 25357
New General Contractor (or Subcontractor)
Reason for Change Not able to do the job
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
agents, and employees from all costs, fees, or damages arising from any and all claims of action for
any reason, which may arise as a result of this change of contractor/subcontractor or cancellation of
permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) / * SIGNATURE OF NEW GENERAL C� ACT%
PRINT NAMEIq� �iGP, {� PRINT NAME
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following in ment was acknowledge core me th' Th
e
followingnowledged before me this
_day of / 20`4 by_ �� d, by
who is personally know to me is personally know to me
or who has produced as ID. or who as produced f V as ID.
acacmcneaar:._e.:-%:saran
Signature of Notary Date PRANCES DONZA Signature of of NZil SPY° .1.., Da f RANCES DONZA:o., Da�RANCE$ DONZA
:2R•c-; , •c MY Ca1r1MISSiON # HH 111471
MY COMMISSION # HH 111471
*Only signat Y" ireEXPF&B:Jv1%&ha�5of bcontracto '•".'F •<o?� EXPIRFS:July27,207.5
Bonded Thru Notary Public Underwriters
°P F ;.• Bonded Thru Notary Public Underwriters
Revised 07/21/1
lil'--f -ayes Z)i�63
PERMIT # ISSUE DATE
COUNTY
F L Q R t D A.
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
ln L 4ti LJ I I J Lz hav agreed to be
(Com any Name/Individual Name)
the Sub -contractor for - r
(Type of Trade)(Primary Contractor)
For the project located at
2904
(Project Stree ress or Property ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
,ONTRACTOR SIGNATURE (Qu Mier) SUB -CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME PRINT NAME
COUNTY CERTIFICATION
4&l��t�""
State of Florida, County of
The Olegoing instrument was sign( before me this07 day of
20u/, by
who is personal y known or has produced a
as identification.
460::1— STAMP
Signature of Notary Public
Print Name of Notary
F�MNCES DONZA
MY COMMISSION # HH 111471
EXPIRES: July 27, 2025
Bonded Thfu Notary y
Revised T1/16/2016
COUNTY CERTIFICATION NUMBER
/
State of Florida, County of G
foregoing instrument was signed before me this0 day of
, 20^ , byJ�.
" who is personally known or has produced a
as identification.
"`►17 ////�i�/„ STAMP
Signature of Notary Pubh'7-
Print Name of Notary Public
FRANCES DONZA
' MY COMMISSION # HH 111471
•=
=�,• :;; EXPIRES: July 27, 2025
c Undornrllers
Bonded Thru Notary Publi