HomeMy WebLinkAboutChange Of Contractor} Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
m - 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:
Permit Number:
Site Address: &L&6,4
( (P U (1z(11C"A� State License SLC License
Original Gen al Contractor (or Subcontractor)
State License C% LC License
e General Contractor (or Subcontractor)
Reason for Change (J�Z
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 contractorlsubcontractor or cancellation of
permit. A permit cannot be cancelled if work has been performed.
IGNATURE OF OWNER (or/ iilder)
PRINT NAMEi /
State of Florida, County of St. Lucie County
Th following ' s rument was ac wledged before me this
day of 20by
o is personally know to me
OZ has produced a ID.
40,2Ut XAi:
���y��
Signature of Notary Date
*Only signature required for change of
Revis W2 14 Notary Public State of Florida
ap Frances Donza
y pr My Commission GG 092440
92'0 ,0- Expires 07/27/2021
IGNATURE OFF/ NEW GENERAL CONTRACTOR
PRINT NAME
State of Florida, County of St. Lucie County
The following ' trument was ackno ledged before me this
day o 20 ��by
�AI l2 �—who is personally know to me
or who as produced as ID/.
O .-
Signature of Notary Date
subcontrRIME
state of Florida
naon GG 09244012021