HomeMy WebLinkAboutCHANGE OF CONTRACTOR - SUBCONTRACTOR 1-4-19•
M
1f® w Planning & Development Services
i Building & Code Regulations Division
®, 2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancz ladon : Per '+
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: I I U i I q
Site Address: --M, 3I SAW (DaLA-
Permit Number: `I wl J U�i
i AJo V � (urlb nQ State License 1) 11QrS LC License
Otiginal General Contractor (or Subcontra tor)
�Awk 411.��a 6� �v� 6 L L el State License GAG / el? Z $ License
New General Contractor (or Subcontra or) et-f'G / y Z75 y j
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.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of , 20_, by
who is personally know to me
or who has produced as ID.
Signature of Notary Date
* IGNATURE OF
W GtNERAL C36NtRACTOR
PRINT NAME
s9 w P s
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of , 20_, by
who is personally know to me
or rod c as ID.
Signature of Not y
120ci
*Only signature required for change of subcontractor
Revised 07/21/14
=a1WY•°4o E
ate of FloridaGG 168732021