HomeMy WebLinkAboutchange of contractor (2)Planning & Development Services
1 - Building & Code Regulations Division
COUNTY 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: 12.23.2021
Site Address: 3937 Shoreside Drive
Micheal Kevin Waish Roofing
Original General Contractor (or Subcontractor)
Sunshine Roofing
New General Contractor (or Subcontractor)
Reason for Change Not able to do the job
Permit Number: 2109-0558
State License
State License
SLC License 29147
SLC License 25357
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.
VIVI,/
SIGNATURE OF OWNER (or o d�nrrer/builder) * SIGNATURE OF NEW GENERAL CNTRACTOR
PRINT NAM ri/ PRINT NAMEZ�OA)
State of Florida, County of St. Lucie County
The following nt w acknowled ed f re me this
20 by g
who is personally know to me
or who as produced as ID.
Signature o otg*',, � CES DONZA
U MY COMMISSIONN # HH 1 1 an of
:.: f
:a. 9 *Only s regp�dJu �2
II
State of Florida, County of St. Lucie County
The following iftyn,wasn
wledged before me this
3 ay of
_, by
who is personally know to me
or who has produc
s D.
Signature of Nota :�' :+ tFOMMISSION # HHJ1111471
EXPIRES: July 27, 2025
... F`Op Bonded Thru Notary Public underwriters
subcontractor
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
(Com any Name/Individual Name)
the I(QL
(Type of Trade)
For the project located at
3q3 7
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
J have agreed to be
for
(Primary Contractor
n,,,o fi/1qr
(Project Street Address or Property Tax 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 SInGN)ATU�(Qfter l
PRINT(NAME
,2�.Z6e -15,52, 3� �
COUNTY CERTIFICATION MBER
State of Florida, County of [�
The foregoing instrument was signed before me this c;Z day of
, io�y
o
who is personally known _or has produced a
as identification.
Signature of Notary Pi
Print Name of Notar
Revised 11/16/2016
SUB-COMTRACTOR SIGNATURE (Qualifier)
>nA /) i C��sr o
PRINT NAME
COUNTY CEItTIFICATION BE
State of Florida, County of
he foregoing instrument was signed before me this da of
by
who is personally known or has produced a
as'den ificat'on.
STAMP STAMP
Signature of Notary Public
t,/ '
MY COMMISSION # HH 111471
EXPIRES: July 27, 2025
Bonded Thru Notary Public Undd
Name of
FRP,NCES DONZA
MY COMMISSION # HH 111471
EXPIRES: July 27, 2025
Bonded Thru Notary Public U�