HomeMy WebLinkAboutCHANGE OF CONTRACTORI
Planning & Development -Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982 SCANNED
(772)462-1553 Fax 462-1578 BY
CHANGE OF CONTRACTOR
St Lucie County
Or Subcontra
Change of Contractor is to be completed
current permit. A new permit applicat
signature, and transfer fee. A new Notii
name for job values greater than $2,;
submitted prior to commencing any i
contractor. Absent extenuating circums
owner and qualifier of record.
Date: September 7, 2018
Site Address' 8036 S. Ocean Drive
or Cancellation of Permit
r the property owner, and the new contractor of record for the
t must also be completed with new contractor information,
of Commencement must be filed in the new contractor's
) ($7,500 if A/C Change -out). A recorded copy must be
rk. Subcontractor changes can be completed by the general
Ices, a cancellation of permit is to be executed by both the
Permit Number: 1805-0033
44 Aq [X/C I State License SLC License
Original General Contractor (or Subcontractor)
William S Hrxon $ I State License CAC1818084 SLC License 27308
New General Contractor (or Subcontractor)
Reason for Change
t� _ /_ n,.,/�
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 worhas been performed.
SI, A RE OF O (or own-% iider) • SIGN RE W NERA C N ACTOR
PRINT NAME 14 PRINT NAME,
i
State of Florida, County of St Lucie County
State of Florida, County of St. Lucie County
�ltg following rostrumt�ackno(%ledged before me this The following instrument was acknowledged before me this
20 by day of°; 20L by
who is personally know to me who is personally know to me
or who rodu ed as ID. orr wh has roduced�y as ID.
Signature of Notary ate Signature of Notary Date
*Only signature required for change of subcontractor
Reviaed
4,py"o% Notary Public State of Florida
,9. , Frances Donza
` MY Commission GG 092440
'�ost►o� Expires07/27/2021
E
KATF LE04 UOUTRAN
MY COMMISSION # FF89049EXPIRES July 13,2019
F
rySamce.cort