HomeMy WebLinkAboutCHANGE OF CONTRACTORSSCANNED
_ Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772114611553 Fax 462-1578
CHANGE
Or
Change of Contractor is to be completed by th
current permit. A new permit application rr
signature, and transfer fee. A new Notice of
name for job values greater than $2,500 (',
submitted prior to commencing any work.
contractor. Absent extenuating circumstance
owner and qualifier of record.
Date: \ r . q `b -\
Site Address:
Original General Contractor (or Subcontractor)
CONTRACTOR
or Cancellation of Permit
: property owner, and the new contractor of record for the
ist also be completed with new contractor information,
'.ommencement must be filed in the new contractor's
7,500 if A/C Change -out). A recorded copy must be
Subcontractor changes can be completed by the general
, a cancellation of permit is to be executed by both the
Permit Number: \�51� QY5'%_Q)
State License SLC License
:ktt�5 �,�� O& � �ic�.� (�Zv�� State License SLC License
New General Contractor (or Subcontractor) i
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.
Q- NATURE OF OWNER (or own r/builder)
PRINT NAME\�V,j
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this i
day ofSDe-° — 20\:, by_\_),FNwc1 �_% �y
who is personally know to me J
or who has produced�h� .was ID.
*XGNATUAE OF NEW GENERAL CONTRACTOR
PRINT NANM Y\ L �y
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
CX'3 day of'
� 20 \5by
who is personally know to me
or who has produced as ID.
`Cc-, �A, G;N� .
Signature of Notary Date Signature of Notary Date
*only signat h n t- f subcontractor •u�rrru�,, STELLA M. HUNTER
;Pav'P&f"� STELLA M. HUNTER
oro` v Notary Public -State of Florida
Revised o7/21/1 • ♦ � : Notary Public - State o1 Florida • « • •? Commission FF n 23, 2
» - Commission #r FF 180552 % My Comm. Expires Jan 23, 2019
M Comm. Expires Jan 23, 2019 �� f OF F�
���,,,,,��• Bonded through Nallanal Notary Assn.
�• Bonded through National Notary Assn.