HomeMy WebLinkAboutCOC REBEL 6485 PSL_1��W�lWr��!:,~·· COUNTY ',
Planning & Development Services
Building & Code Regulations Division UGO Virginia Ave.
FlOlilDA "-Fort Pierce, FL 3498% (772)462-1553 Fax 4'2-1578
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 fded in the new contractor's
name for Job values greater than $2,500 ($7,SOO ff 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 pennit is to be executed by both the
owner and qualifier of record.
Date: 2-2-22-----------
\ .
Permit Number: SLC2110.0883 ---------
Site Address : 6601 s us 1 -----------------------------
_sTE_PHE_N_M_KE_MP _____________ State License ______ SLC License ___ _ Original General C.Ontractor {or Subcontractor)
ST LUCIE SIGNS LLC State License ES12001557 -------------------SLCLicense -----New General Contractor (or Subcontractor)
Reason for Change NO WORK PERFORMED JUST PULLED PERMIT UNTIL CONTRACTOR CHOSEN
The undersigned does hereby agree to indemnify and hold hannless 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 pennit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER ( or owner/builder)
PRINT NAME �c'.I� A ngbi"
State offlorida, C01lllty of St. Lucio Comity
The followiug imtrument wa& admowlcdgcd belme me thia
__ dayof ___ _,,20_, bY, ___ _
_______ w11ouperaoaa11yknow��
or who hu piodu(:cd _______ as ID.
Sipatare of Notary Date
�"'-�. SI OF NEW GENERAL CONTRACTOR = JAMES MICHAEL NOLE
State of Florida, County of St. Lucic County
� following instrument waa iu.kuowledgcd before me Ibis___l_11ayor"lAt-11ARR,20.B., by A ES NOLE
_ ______ who ispersonallykllowtome
or who hasproducod ____ as ID. On«:k: .,,. , � , .. � 1.0"2,'2,.
�or Notary Date
*Only signature required for change of subcontractor
Revi,ed 07/21/14 -•"f .... JADE LEE K�ST
Notary l'ublic · stl&t !if F commtssian # GG 261 .
My Comm. Expiris � 25, 1tit
· • 3or�PI t�r,,. t,>-1/�t•or•' 'IJ!il'\' �ssn. �.,,_,,. .............. �.
JAMES MICHAEL NOLE
J M
CALIFORNIA CERTIFICATE OF ACf<NOvVLEDGIVIENT ___ ,_, __ ,, ... _._ ·-·· ·� · ... ........ .. ,.. ... ----···--·-·-····. ____ .,· -�---·-·-··••··'·•· .. . · .. : ., .. ., __ ._ ... -·•----·-· -.. : ... · ....... ·,·; .... "· ............ -·· ... : ..
State of California
Countyof S�n .... llit.rrocc.\t�O
On .\>-�U'J\�-�r __ rt,_�L bef ore me, __ be&\nDa ...... -P:: . .-.. S�ee(, \.\1x\:l,\(4 P.�X?��c I 1 · • ··-.... , ti! .... ,,.1 1 •;. 1 �•;• if-,••/,
personally appeared ____________ .. f0.�-·--··���-· ___ ... ----·· _. --•··--·----·--··--------.. ,-..... _______ __
--------·-·-----.. -... --•-·-·-·-•---·· ... · .... --------... •·--------------------------
who proved to me on the basis of satisfactory evidence to be the person(� whose name¢)8Yare subscribed to
the within instrument and acknowledged to me that he/�/they executed the same in his/�/their
authorizell capacity(i�). and that by his/&/their signature(,fon the instrument the person�, or the entity
upon behalf of which the person�· acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the
State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
•• DEANNA R. SPEER0
.. ' COMM. #2344810 z Notary Public -California ! San Bernardino County .. M COmm. E ires Feb. 2, 2025
(Seal)
•., • '•• ••'•"• ;, • •• " . • • • •• • •• '• • • • ' '•• • � •• ,. I •• • • •· • ·• ' ., .. ' • '•• • '" . , ' '. •• '•• • '• •• • • • ""' ' " ,. ' • • •· •• • •• . • ·• •, ... ,, • •• • ' ',• • y •• ,, ' ' """' -.. ·--�---�-. ___ .,......_ __
Optional Information
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