HomeMy WebLinkAboutChange Of ContractorPlanning & 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 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: 12-7-2015
Permit Number: - \ `=7�� Ic�j
Site Address' 10725 S Ocean Drive Jensen Beach FI 34957 nl b
R J Allen Electric
Original General Contractor (or Subcontractor)
Joes Electric of St lucie County
New General Contractor (or Subcontractor)
Reason for Change orginal contractor to busy
State License SLC License EC13006572
License
SLC License 4267
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.
&J R1 P
SIGNATURE OF OWNER wner/builder)
PRINT NAM�Q�\,�
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of f 20\ b
who is personally knoMto e
or who has produced as ID. r
Signature of Notary Date
Gz�4a 7ff-,, �-, —
* SI ATURE F NEW GENERAL CONTRACTOR,
PR NT NAM��'!_ / L/ e1�11 ��✓�
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_\_Sby—a `
who is personally know to me
or who has produced as ID. _
Y�) _�\_\�
Signature of Notary Date
*Only signature required for change of subcontractor
Revised 07/21/1 .`"� , STELLA M. HUNTER
d '.
Notary Public - State of Florida
Commission # FF 180552
♦ r.
My Comm. Expires.Jan 23, 2019
Bonded through National Notary Assn. e
?o-08 PR"
,• . *�__
STELLA M.TER
HUN
Notary Public
x r
,
*��
. State of Floi;
commission # FF 180552
""'"
My Comm. Expires Jan 23. 2
90ndedthrough National
Notary a ,.