HomeMy WebLinkAboutCHANGE OF CONTRACTOR09/16/2017 08:02 5616591197 DISALVO FINANCIAL
PAGE 03/03
RECEP.":D SEP -02017
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ara.
Fort Pierce, FL 34982 I�
(772)467,1553 Fax 462.1578
CHANGE OF CONTRACTOR
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 nevv 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 oircumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
SCANNED
Date: 7 to -e l /
Site Address:
5 0 1r - 0 G-a'j
l ) m (S Jn1k State License SLC License IAQ6
Won] General Contractor (or SubconhActor)
�i Inn State LicenseCAGI ?Jk01ogSLC License
New General Contractor (or Subcontractor) /
Reason for Change 7 �aAj, &L�.'k l(D JW1 lfl wire
The undersigned does horeby agree to indemnify and hpld bamilas 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(snbcontractor or, cancellation of
permit. A permit cannot be cancelled if work has been performed.
SIGNATURE O/''W�' (drown
PRINT NAMi{ X[VtoS L I�
state ofrinrldn, County of St Lucia County
The fialowln3l tru nl was neboMedged befbm me this
day o�0by
who is personalty know to me
or 'o has producod as ID.
t aA 4-
Signature ofNotnry Dah
m Flodds
*only , iCUA9 o Ran s par chan
33' Ran a
aavioad Expo o D lesion GG 092440
"orF
Susie of Floddn. County of St. Lucie County
no fbllawins instrument use acknowledged before me 41
diry of —20 /7 N itl • $C[rdd- 3 •mom
_who b Personally knout me Y'�'r
,
orw��hby,I.ad uud �y
(rYl tler'ia7V52PN 9/2oliy
Slgnature ofNnrnry nAte
of subcontractor
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 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 Sled 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:
Site Address:
�l
Permit Number:
State License SLC IP(009
Orfin ' al General Contract r (or Subcontractor)
P
State LicensLC License11
'
New Genera ontractor (or Subcontractor) n
Reason for Change CA,07ac�l f �/ i�/
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{JA, pRj (or �oryw.ner/buiillddeeJr))
PRINT NAMF,�y i . fggy U�/
State of Florida, County of St. Lucie County
The allowing i ment was at ]edged before me this
d y o 2 by
LZ ho is personally know to me
or who h"roduced 4 as ID.
*Only eF->"oi"c
My Commb0100 00 002440
Revised 7RX,dF DPW, 07127/2021,
'SIGNAT RE OF NEW GENERAL CONTRACTOR
PRINT NAME/ - �///
State of Florida, County of St. Lucie County