HomeMy WebLinkAboutChange Of ContractorJ Planning & Development Services
Building &' Code -Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772062-1553 wax 462-1578
CHANGE OF CONTRACTOR
Our 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 infomudon,
signature, and transfer fee. A new Notice of commencement- must be'Med in the Row contractor's
name for job value's 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. Any cancellation of permit must be executed by the owner or qualifier of record.
Date: 107/ 9-/'1-5
Permit Number: 1408-0067
Site Address: 100 Island Dunes Cove, Jensen Beach, FL
c Construction zz-
State License SLC License
Original General Contractor (or Subcontractor)
--Ault Bros, Inc_. Electrical State License EC0001693 SLC License 16568
New 0MIdBM=MX0r Subcoabutor)
Reason for Change Conflict between original Electrical Contractor and General Contractor
Tbe undersigned does hereby agree to indemuf�and hold harmless St. Lucie County, its officers,
agen% and employees from all costs, fees, or damages arising from any.and all clahns of action for
any reason, which may arise as a:result of this change of contractors/subcontractor or cancellation of
P
SI TfJRE OF OWNER (or owner/builder) "�SIOXM&OFNEW GENERAL C CTOR
PRINT NAME PA-4 Wit-' (f-` �-v UC \ PRINT NAME -G�c I c. C � 1�
State of Florida, County of St Lucie Con*
Stxtc of F'loridN County of St. Lucie County
The Mowing instrument was acknowledged beibre me. this The futlowing imt umt was acknowledged before me this
rU' c —�...� -._ .._. ........._ day 20� �, by � cc
who is personally know to Mc [ C -i who is personally know to me
or who has pmdacod as ID. r who b produced as ID.
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SkgnatureofNotilry Date SignatureofNotary Date °
MINNIE KATRINAWRIGHT
A Notary Public, State of Florida
*Only signature requir®d i ar change a subcontractor Ar Commission# FF 1,1313
res Aug.
10, 2018
My COMM. expi
OCT 21 NO
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