HomeMy WebLinkAboutCHANGE OF CONTRACTOR 4-1-14BY
ipia NilfiW
Planning & D
Building & Cod
2300
Fort Pi
(772)462-1
CHANGE OF
velopment Services
Regulations Division
irginia Ave.
,ce, FL 34982
i3 Fax 462-1578
NTRACTOR
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 C,
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: /0 65-1 . S 011.p
Original General Contractor (or Subcontractor)
New General Contractor (or Subcontractor)
Reason for Change
The undersigned does hereby agree to indemnif�a
agents, and employees from all costs, fees, or dam.
any reason, which may arise as a result of this char
permit. A permit cannot be cancelled if work has be
SIGNATURE OF OWNS or owner/builder)
PRINT NAME_���J//f�/�%i/�
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
2 C�_day of 20J�e, by e $
C r Aoy de-7who is personally know to me
or who has pr �edny2csl ice�Da
.
nature of Notrte
*Only signature required for change of
Revised 07/21/14
amencement must be fled in the new contractor's
)0 if A/C Change -out). A recorded copy must be
)contractor changes can be completed by the general
cancellation of permit is to be executed by both the
Permit Number: 1,7flZ `' 0/ � j
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
PRINT
State of Florida, County of St. Lucie County
Whe following instrument was acknowledged before me this
day of . 20_, by
who is personally know to me
who has produced as ID.
Signature of Notary Date
ractor
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