HomeMy WebLinkAboutCHANGE OF CONTRACTOR 4-11-16- 1
ktt%EIV'D APR 112016
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
. Fort Pierce, FL 34982 ���N�
(772)462-1553 Fax 462-1578 �Y E®
�t �.UCIe C
CHANGE OF CONTRACTOR OU"Vf
Or Subcontractor or Cancellation of Permit
Change of Contractor is to be completed by the propertylowner, 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: 3/25/2016
Site Address: 8630 S. US Hwy 1, Port St. Lucie, FL 34952
Great Dane Petroleum Contractors Inc S
Original General Contractor (or Subcontractor)
Mulligan Constructors Inc. S
New General Contractor (or Subcontractor)
Reason for Change
The undersigned does hereby agree to indemnify and
agents, and mployees from all costs, fees, or damage
any reason which may arise as a result of this chang(
permit. A ermit cannot be cancelled if work has been
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME YV11IiiOM ln� Adam
6�a.
State of , Countye�e-@041ty I"IQ�State of Florida, County of St. Lucie County
The following i strument was acknowledgeacknowledgecL before me this IThepfallowing instrument was acknowledge before me this
0 da of Or(-h , 20�1, by 1(I � d 7j+day of 4r4^ , 20]k, by C( &'%
I
nV0 AA who is rsonally know to me 1 N� 01 Y� who is personally know to me
wllo has produce as ID. ��/ I or who
le
ignature of Notary Date Signat
Permit Number: 1410-0401
License Q S y 13 SLC License
License CGC1510462 SLC License
cold harmless St. Lucie County, its officers,
arising from any and all claims of action for
of contractor/subcontractor or cancellation of
*Only signature require, ,.-,�� Ruint"1>1
b1
Revised 07/21/14 NOTARYI
ROCKDAAE COUNTY
STATE 1rGeEs A vst 16. 2019
�,1y �mmiss
OF NEW fENERAL CONTRACTOR
Jasoh Mulliaan
as ID.
re of Wtary Cam
—
JENNIEBACH
COMMISSION # FF 015887
acto
='i
MY 5,2017
EXPIRES; July rders
a:� .,,;c '
Bonded TW Notary Public