HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
® o Fort Pierce, FL 34982
�. e (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 ($79500 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: ?/P- Permit Number: �l 22— F
Site Address: / a C
S r00 oKe i4, ALL, State License SLC License
Original Ge eral Contractor (or subcontractor)
/— State License z f, //zt'-%5,7SLC License
New General Contractor (or subcontractor)
Reason for Change -2-- 45— /ee
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.
IGNA' OF OWNER (or owner/builder)/ m SIGNATURE OF NXW GENERAL CONTRACTOR
PRINT NAMEAZL- PRINT NAME_4�d 1`G le
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
who is personally know to me
Orr s produce ! as ID. 1
Wiz+" 4� ' r t �S{�•��/a � ! �' r� Z�
Signature of Notary Date
State ofFlorida, County of St. Lucie County
The following instrument was acknowledged before me this
y of b f� , 202- by � E-, M, Ltl/
who is personally know to me
or who h produced
�;1F0 .j /A:-2 ?�/ Z
Signature of Notary Date
*Only signature required for change of subcontractor
Revised 07/21/14
FE
0AL of LISA FASNACHX
-Notary Public -State of Florlda Commission 8 HH 183855���RaP: Nly Commission Expires
-)ctober 09, 2025
-�•�"�p�.,, LISA FASNACHT
° Notary Public -State of Florida
=`® Commission # HH 183855
%� d�'.� M Commission Expires
���� ��"��` yOctober 09, 2025