HomeMy WebLinkAboutCHANGE OF CONTRACTOR �BY
Pla i fnf&r M1Jo Jhent Services
Building & Code Regulations Division
;. 2300 Virginia Ave.
gi s Fort Pierce,FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Permit
Clange of Contractor is to be completed by the property owner, and the new contractor of record for the
c ent permit. A new permit application must also be completed with new contractor information,
si I� ature, and transfer fee. A new Notice of Commencement must"be filed in the new contractor's
n me for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be
s bmitted prior to commencing any work. Subcontractor changes can be completed by the general
c intractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
o �I ner and qualifier of record.
D''� te: l Hof 4 o, o�0�co Permit Number:
S It e Address: Y l
J �Piz State Licens 625LC License
Oiriginal General ontra or(or Subcontractor) 0 State Licensed LC License
w General Contractor(or Subcontractor)
ason for Change Se a _ 1 e— — c L d, e_ o
he undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
a'ents, and employees from all costs, fees, or damages arising from any and all claims of action for
a,!y reason, which may arise as a result of this change of contractor/subcontractor or cancellation of
pi rmit. A permit cannot be cancelled if work has been performed,
NATURE OF;rR (or owneribuilder) *SIGNATURE OF NEW GENERAL CONTRACTOR
PRINT NAME ti �� r\Q 1 -� PRINT NAME
II
fate of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
�'he
following instrument was acknowledged before me this The following instrument was acknowledged before me this
� day of Via,✓ 20k,by day of 20�6 by
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o o is personally know to me /�I T Te 1 f who is personally know to me
Fwho has produced as ID. or who has produced as ID.
1 u„ Signatu �.
ignature of No r�i�n:ry,�,,- Da14iANCEB DONIA ;• Y py,,�
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