HomeMy WebLinkAboutCHANGE OF CONTRACTORM� Planning & Deffi"'R �PvVe's ��:,� e�
' ]Building ld.,� l . f,
g & Code Regulations Division
2300 Virginia Ave.
A..., _• ..._ ' __' Fort Pierce, FL 34982 MAY 1 2090
(772)462-1553 Fax 462-1578 PEFCAiTTiNG
5
CHANGE OF CONTRACTOR t. Lucie County, FL
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 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: 5/11./16
Site Address:
Permit Number:
Richard Manning Woodley 1
Original General Contractor (or Subcontractor) State License CBCA17970 SLC License
Scott Harala
State License CGC1506052 SLC License
New General Contractor (or Subcontractor)
Reason for Change Richard Woodley left company
ii;
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.
SIGNATURE OF OWNERS +(or owner/builder)
PRINT NAME J L c-4 ��sL
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
5 dayof May 201e
--___ _, by
Scott Harala who is personally know to me
or who has produce
OWN
07
Signature of No spit
Q Expw November 4, 2018
bonded Thru Troy Fain Insurance 900385-7019
*Only sign
* SIGNATURE OFFNEW -RD4 -
GENERAL CONTRACTOR
PRINT NAME SCOtt Harala
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of May 20 16 by
ar }vhe is persona y know to me
mi , h p E �@�s FF 14060WsID.
8
oc
i•u e o d'St r
equired for change of subcontractor
Revised 07/21/14