HomeMy WebLinkAboutCHANGE OF CONTRACTOR\._. SCANNED
i BY
St Lucie County
Planning & Development Services
tw 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: Wj4x Permit Number: &
Site Address:
rJ
State License SLC License
Original General Contractor (or Subcontractor)
` ,Affiftng%� State LicenseCkI .SLC License
New General Contractor (or Subcontractor)
Reason for Change
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.
4
SIGNATURE OF OWNER (or6 ner' ui der SIG OF NEW GENERAL CONTRACTOR
PRINT NAME �`^-eS �l /tF— PMT NA vffi _ _ �
State of Florida, County of St. Lucie County
The following ins ent was ackno ledged before me this
O day of� 20by
,_kmi 5 I(AA� who is personally know tome
op�edo ID.
Signature of Notary Date
qld opher D. Shearer
*On gnatur&atg6ftdfted for
Revi• ` / zi q ISSIM 000 002021
rlMfWon No. GG 112235
State of Florida, County of St. Lucie County
The following i ment was acknowledged before me this
Ajtday of. V Q� 20& byy
��// who is person ow t me
or wh has producedt. .
Signature of No Date
change of subcontractor
;� ;I, / to y
o ,Ain +:Pp, AUDREYB HUMPHREY
._ MY COMMISSION # FF 174772
s EXPIRES: March 6, 2019
a'fRf¢ Bonded Thru Notary Public Undenxriters
.i
PERMIT # ISSUE DATE
v4.
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
L(_Of
have agreed to be
(Company Name/Individual Name) v
the 21_1"� 6 / 4, � Sub -contractor for 11.Y/li2 ve 61,L �—
(Type of Trade (Primary C ntractor)
For the project located at �f 7�0 �� ,/��,� c e �C
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of
C CTOR SIGNATURE (Q er)
TA .w/1 �TT
PRINT NAME
cFC/U27,,�i/ � , '•
COUNTY CERTIFICATION NUMBER
State of Florida, County of R�fiJ N
The foregoing instrument was signed before me this day of
P (—, 20LU, by <1A m 1S PC 00.1
who is personally known _or has produced a �:C' -�p l✓
as identification. Christopher D. S taw
State of Florida
C=ftim a I M/P021
ature of Notary Public « COIi1aWW Na M 112236
C 1r15A'gDJ -p- G)MaP6(
Print Name o Notary Public
Revised 11/16/2016
SIGNATURE
CCRJNTY CERTIFICATION NUMBER a
State of Florida, County of A1x'1_
i
The foregoing instrument was signed before me this ,yof
20 by & LW
who is perso own or has produced a
as identification. ,,
D—'...a WT.........P 1V..�..-.. ..{.l'..
=qw• ,Py�c ,
MDREY & HUMPHREY
MY COMMISSION # FF 174772
EXPIRES: March 6, 2019
a' 9.
Bonded ThruNotary PubraUndenwiters