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Home My WebLink AboutChange Of Contractor2016-01-08 11:34 TRI R CONSTRUCTION 7723366486>> P 1/1 Planning & Development Services Building & Code Regulations Division 2300 Virginia Ave. Fort Pierce, FL 34982. (772)462-1553 Fax 462-1578 CHANGE OF CONTRACTOR 11` Cz1 4, AN 18 2®16 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: Site Address: Permit Number: (�' 1 C +� rA_State License e C-032 / License Original General Contractor (or Subcontractor) I New General Contractor (or Subcontractor) State License I _SLC License Reason for Change Q ��s2__ U (�jptJC"7 10 7� &/41 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 contra or/subcontractor or cancellation of permit. , SIGNATURE OF OWNER (or owner/builder) PRINT NAME State of Hlotida; County of St. Lucie County The following instrument was acknowledgcd bcforc me this day of . 20_ by who is personally know to me or who has produced as M. Signature of Notary Date *only signature required for P-al 2-- ;7u Y CONTRACTOR PRINTN State of Florida, County of St. Lucie County The following instrument was w4mowledg�e9d before m�e,, this day o 20&, by who is personally know to me r wh p uced �as ID, / P Signature of Notary / Date ,�`!;Pi4;b ► PEDAOWLALONBO k *DIY COMMISSION r FF INSIS change of subcontr EX ES: Febrdp 23,2019 °'�F�F�dr �ndedTh afr�amry5err= 21 RE E E..o Planning & Development Services JAN 1 12016 Building & Code Regulations Division 2300 Virginia Ave. PER�dIITTING Fort Pierce, FL 34982 St. Lucie County, FL (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 extenuatJIng circumstances, a cancellation of permit is to be executed by both the owner and qualifier of record Date: 01/07/2016 Permit Numbe . , 310-000s Site Address: 515 Nettles Blvd, Jinsen Beach, FL Tri-R Construction State License CCC 1329772 SLC License 27090 Original General Contractor (or ubcontractor) Sunrise City CHDO State LicenseCCC I `3 a v4SLC License 25600 New General Contractor (or Subcontractor) ntractor) Reason for Change Failure to perfor Ti The undersigned does hereby �gree to indemnify and hold harmless St. Lucie County, its officers, agents, and employees from al costs, fees, or damages arising from any and all claims of action for any reason, which may arise asl a result, of this change of contractor/subcontractor or cancellation of permit. A permit cannot be can felled if work has been performed. &a-��,�6" � W SIGNATURE OF OWNER (or o er uild r) *SIGNATURE OF NEW GE14ERAL CONTRACTOR PRINT NAME � er PRINT NAME State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County The following instrument was acknowledged I efore me this11� J The following instrument was acknowledged before me this day of 20_L&by� �77 / yRer `� day of 120t by ho is personally know to me who is personally know to me or who as pro uced as ID. 50 o has prodg5 as ID. I Al JAI 1� 1 Signature of Notary Date I Sign tary Date *Only signature required Revised 07/21/14 r change of subcontractor KAREN S. NIELSEN rn Co mission 4f FF 115637 i�'rF Oif �� M;% Commission Expires � June 12, 2018 11 PEGGY LINARES Notary Publid - State of Florida My Comm. Expires May 8, 2018 +, Commission # FF 121291 Bonded Through National Notary Assn.