HomeMy WebLinkAboutCHANGE OF CONTRACTOR-- I
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OFJ CONTRACTOR
Or Subcontractor or Cancellation of Permit
Change of Contractor is to be completed by the
current permit. A new permit application mu;
signature, and transfer fee. A new Notice of G
name for job values greater than $2,500 ($7
submitted prior to commencing any work. S
contractor. Absent extenuating circumstances,
owner and qualifier of record.
Date: �� ✓ /�
Site Address: /CT,: / �( 0
Original General Contractor (or Subcontractor)
New General Contractor (or Subcontractor)
Reason for Change
The undersigned does hereby agree to indemnif
agents, and employees from all costs, fees, or dI
any reason, which may arise as a result of this c
permit. A permit cannot be cancelled if work has
[GNAT E OF OWNER (or owner/buf der)
PRINT NAME / _/ Q/
OUTA NNMJ
)perty owner, and the new contractor of record for the
also be completed with new contractor information,
imencement must be filed in the new contractor's
10 if A/C Change -out). A recorded copy must be
icontractor changes can be completed by the general
cancellation of permit is to be executed by both the
Permit Number: % Y// 00 Z_ e
1 VW__
State License
State License
SLC License
SLC License
hold harmless St. Lucie County, its officers,
;s arising from any and all claims of action for
of contractor/subcontractor or cancellation of
performed.
* SIGNATURE OF NEW GENERAL CONTRACTOR
�gy t , �iC/y/1� PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
D41day of G I .r ^ r 0 20_�_ by , fi t
r612n 7 who is personally know to me
or who has pr duceddE ,,p� 1: , c as ID.
ig�of Notary Date I G
� State of Florida, County of St. Lucie County
a e following instrument was acknowledged before me this
day of . 20_, by
who is personally know to me
� JHwlohasprdeM as ID.
Signature of Notary Date
*Only signature required for change oflsubcontractor
Revised 07/21/14 \
K57