HomeMy WebLinkAboutCHANGE OF CONTRACTOR - SUB CONTRACTOR8 iIdinS
PeIMI
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of P
SCANNED
By
St. Dacia Cow
[RIEE
B - � P019
ng Departmentie County, FL
of Contractor is to be completed by the property owner, and the new contractor of record for the
: permit. A new permit application must also be completed with new contractor information,
Ire, and transfer fee. A new Notice of Commencement must be filed in the new contractor's
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be
tted prior to commencing any work. Subcontractor changes can be completed by the general
;tor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
and qualifier of record.
Dae: 1l tip) �� Permit Number: �SV,-1906 - ON 0 f
Sit Address: 018 S ar 11-0 n ?,0(• PQ r+ Si-• LAC.i e 1 PL- 3 c1 q 9 i
Waavler $grn er s Etr jG State License TH 10251i3.$ SLC License
Original Ge eral Contra for (or Subcontractor)
r
Ecm w1 oaa Selet-IYIIGI In C_ . State License EC 13 Do 559,5�_SLC License 2-Sq 1-1
Ne I General Contractor (or Subcontractor)
Rellonfor Change LOCc,ii•0n 0-F new Sob lS C1ofer 40 Jvb St-��
Thy' undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
age f� its, and employees from all costs, fees, or damages arising from any and all claims of action for
anreason, 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.
U If gi—&,= �_ "_
SIG F O (or owner/builder) -ISIGNATURE OF NEW GENERAL CONTRACTOR
PRI qT NAME �} Q �¢ O Os ►1eY— PRINT NAME,yC, ^. / l rY�or.,_1�J
•�a 0- �Yl
Statelof Florida, County of St. Lucie County State of Florida, County of St-ee
The I i llowing instrument was acknowledged before me this The following instrument was acknowledged before me this _
ZI ay of , 20 , by I S�-day of 5 20 j , by rrL� Yam. i 3 ar�i g
nip who is personally know to me whooiis personally know to me
or wh has prod ced as ID. or who has u uced � �� U as ID.
Signa ure of No ary Date Signa ure o Notary Date
*Only signature required for change of subcontractor
O,t�y s Caiene Edlund-Chen
NOTARY PUBLIC
Revised 07/21/19 ESTATE OF FLORIDA
t APRIL LYNNE MONROE ? Contra# GG011599
c` Notary Public . State of Florida NCE 19�� Expires 7/13/2020
` of boCommission # GG 262286
"' My Comm. Expires Sep 29, 2022