HomeMy WebLinkAboutChange Of ContractorPlanning & Development Ser
Building &. Code Regulations .1E
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
current permit. A new .permit application must also be .complete,
:signature; and transfer fee. A new. Notice of Commencement mu4
name: for job values greater than $2,500 ($7,500 if A/C Chang
subiYitted prior` to -commencing: any work. Subcontractor change
contractor. Absent extenuating circumstances, a cancellation of pi
:owner and qualifier of record.
:Date: Permit Nui.
:Site Address: L4 !� b 'I) f l 1i�e_,
5 e yQJj VOA a :l State License 6c—
`O�ln al General Contractor (or Subcontractor)
State License
: <> New General Contractor (or Subcontractor)
y Reason for Change .ri.11
e new contractor of record for the
vith new contractor information,
)e filed in the new contractor's
iut). A recorded copy must be
can be completed by the general
nit is to be executed by both the
)-7/0-- 07i 7
bnb5b�
SLC License
Jv
SLC License c:P-2j�%_
The undersigned does hereby agree to indemnify and;hold hazriless S#. -Lucie County, .its officers, .
agenfs, and:emplgyees.:from all costs, fees, or damages..ansing from any and all claims:of action for
any reason, whicl .may.anse as a result of this change of contractor./subcontractor or cancellation of
permit: A,permrt cannot b'e cancelled if w.ark has been-peref
SIGNATURE OF;OWNER .(or owner/builder)
PRINT ,NAME
State of Florida, County of St. Lucie County
The>following instrument was acknowledged before the this
day of , 20_, by
who is personally know to me
or who,has produced as ID.
* $16NATUREJOAN
PRINT NAM E
State of Florida, Cow
The following instnu
Wday of eYA
u A1.90 -
c; who has produced
Signature of Notary Date Signature of Not
*Only signature required for change of subcontractor
Revised 07/21/14
St. Lucie County
ras acknowledged before me this
20yb I �J
wh rs� lno me
SYLVIA LOMW'072
MY COMMISSION d FF 936294
EXPIRES: February 22, 2090
®®nded Thru Notary Pubrx underwrters
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