HomeMy WebLinkAboutChange Of Contractor 8-15-14Planning & Development Services
Building & Code Regulations Division
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 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: ? l :S I q-
Permit Number: �r: • 00 T%
Site Address: fjCLlllh )—, \ _
Cb 0l_ T
_Tx)r)1(= rPL O IN State License SLC License t=� V )��,
Original General Contra for (or Subcontractor)
A'lilbO/L9AdDO 9,144tZ3/ —: iT mate License /O 36 3 SLC License
New General Contractor (or Subcontractor)
Reason for Change
IRS
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.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20� by
who is personally know to me
or who has produced as ID.
__ z�
* S10IXTURE OF NEW GIffNERAL CONTRACTOR
PRINT NAME / y,
State of Florida, County of St. Lucie County
The following ins ent was acknowledged before me this
�dayof -V20JYby_! 1L P_p N&
who is personally know to me
or who h'as produced R- as 1D./F'/ C,-
Signature of Notary Date Signature of Notary Date
G &.0- V-ST () .
*Only signature required for change of subcontractor
;r ;p!'"•. AUDREY 8. HUMPHREY
MY COMMISSION tl EE 061159
EXPIRES: March 6, 2015
a-
�pf� Bonded Th[u Notary Public Underwriters
Planning & Development Services
Building & Code Regulations Division
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 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: '9° 1 S r'C Permit Number:— 'R� • �D^]
Site Address: Va 3a So , ®ems i21'ye , -�s.e)
State License SLC License�7
Original General Contractor (or Subcontractor)
k3ae,o glecwaLe4 ,V, r-L • State License 0e1-?",?a,6' SLC License
New General Contractor (or Subcontractor)
Reason for Change %� V&cl-) SO 93jP
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.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St. Lucie County ------ =�;, State of Florida County of St. Lucie County
The following in ent was acknowledged before me this The following instrument was acknowledged before me this
day of 1� 20-Nby Gf 2014 day of . 20_, by
who is personally know to me who is personally know to me
or who has produce �I °�r ho hh produced ID.
Signature of Notary Date
Signature of Notary Date
*Only signature required for change of subcontractor