HomeMy WebLinkAboutChange Of ContractorPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave:
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
1
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:!
Site Address: O 6 C;?4
Permit Number:
I'�Aw-'e-4, I o State License SLC License
(3riginal Gener 1 Contractor (or Subcontractor)
v-�Im6ft.6tzm a"qt u g State License -1_v' SLC License
N General Contractor (or Subcontractor) Y
Reason for Change
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.
S GNATURE OF OWNER (or ow
ne
r/bu
ilder)
PRINT NAME
State of Florida, County of St. Lucie County
The following ' trument was acknyRwledged before me this
day o 20/! , by
L. who is personally know to me
or who has produced A s ID.
Signature of Notary U Date
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- XIGNATURE OF NEW GENERAL C T/ CTOR
PRINT NAME 4/fi
State of Florida, County of St. Lucie County
I ThThe ollowing in ment was acknawledged before me this
day of 20�, by
d who is personally know to me
or who bWproduced /% as ID.
Signature of Notary Date
*Only signaturerlf�
C a �afF�idasu ontra tQ NotaryPubli-State ofFWAdallotary Public Frances Donza
Revised 07/21/14Franc8SDOnza My CommissionGG092440 My Commission GG o92440�a Expirbs 07127/2021
Expires 07/27/2021