HomeMy WebLinkAboutCHANGE OF CONTRACTORSCANNEL
BY
St Lucie County MAY 1 1 20N,
Planning & Development Services
J Building &Code Regulations Division Publi`
St. Lucie
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: 5/11/16
Site Address: 3D30 Nw 1 c�
Richard Manning Woodley
Original General Contractor (or Subcontractor)
Scott Harala
New General Contractor (or Subcontractor)
Reason for Change Richard Woodley left company
Permit Number: 1 S(2 -04UL
State License CBCA17970 SLC License
State License CGC1506052 SLC License
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)
PRINT NAME_�L
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
5 day of May 20 16 b
Y
Scott Harala who is personally know to me
or who h
`pAY 40607
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Signatu e= F, fiber 4, 201
Expires N
;�••• �.•` Bonded Thru Troy Fain Insurance 800.385-7019
*Only ure required for change of
Revised 07/21/14
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* SIGNATURE OF NEW GENERAL CONTRACTOR
PRINTNAME SCOtt Harala
1
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of May 20 16, by
Scott Haralr who is personally know to me
or who has pr ce as ID.
Signature of Not 20 °a:� ;
. =
�SE BROWN
Commission # FF 140607
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subcontractor
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Expires 4, 2018
November
Bonded Thru Troy Fain Insurance
800-385-7019