HomeMy WebLinkAboutCHANGE OF CONTRACTORSPlanning & 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 ($7,500 if A/C Change -out). A recorded copy must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: 2 1/1. ($
Permit Number: 1 HOC - 8396
Site Address: OUV - 138z-S- -T. :t-n ,'., Awe, Dr. TrhS-rt C3ec�c�,
POWe.r:3 600640c kv, aC State License C(,6105,Q t SLC License
Original General Contractor (or Subcontractor)
,5-004Lev>n ��C. State License rLCN(15-Issp7 SLC License
New General Contracto r Subcontractor) r
Reason for Change Ko
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. --""—
SIGNATURE OF OWNER (or owner/builder) * SIGNATURE OF N GENERA'�L®CON�TRACT
PRINT NAME PRINT NAME YI/i1(6.e1IUVIOAD
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of , 20_, by
who is personally know to me
or who has produced as ID.
Signature of Notary Date
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
Zh) day f �2,b 201e,by tM,f14
who i tfersonally know to m
or who has produced as II).
2 /S
Signature of Notary Date
*Only signature required for change of subcontractor
Revised 07/21/14
$Rwl HILL
OV�i
1 — 1, Notary Public - Side of Flor a<
Commission M FF 930966
•c Comm.y Expires Oct 26, 2019
N, d o, al Ndwy Assn.
l Bonded tlrougfi Nation