HomeMy WebLinkAboutCHANGE OF CONTRACTOR 12-9-14Planning & Development Services SGANNiE®
Buildin& Code
o � g Regulations Divisionl�C[By
Virginia Ave.
' R I D A Fort Pierce, FL 34982 hv1p. {�, f"j} im 1p9
(772)"2-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or SIubcon c r ante lation o ermit
Change of Contractor is to be completed by the property owner, and the new contractor of record for the
current permit. A new permit l 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: L
Site Address: / o
Permit Number: / bdS�l
tate License SLC License T3
Original General Cont /tor r Subcontractor)
State License G SLC License �o?
D*CGIene—,
al Contractor (or Subcontractor)
Reason for Change
The undersigned does hereby agl
agents, and employees from all c
any reason, which may arise as a
pent. A pe*Wt cannot be cancel
SIGNATURE OF
PRINT
State of Florida, County of St Lucie County
to indemnify and hold harmless St. Lucie County, its officers,
s, fees, or damages arising from any and all claims of action for
iult of this change of contractor/subcontractor or cancellation of
if work has been peZIE
` SIGNW GENERAL O CTOR
PRINT NAME
The following instrument was acknowledged before me this
day of, , 20, by Nk #-p L
who is personally know tome
or who has produced L=__as ID.
-7
gnu a otary
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
4day ofjk� 20 f- by_ JgLI A^✓
1e, (PfM Wk who is personally know to me
or who)w produced 'F� (i as 117.
_- fir` 112
Signature or Notary Date
MELISSA L SULLIVAN
y signatu e r quired for change of subcontractor NOTARYPUBLIC
R
uuuq,
ELVIS R. ROCK
Notary Public - State of Florida
;N9c •o;; My Comm. Expires Sep 21. 2016
•.,a�� ;°P` Commission # EE 834942
STATE OF FLORIDA
. Canm# FF099860
Expires 3=2018