HomeMy WebLinkAboutCHANGE OF CONTRACTORCOUNTY
FLO R .1 D,A
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
/90s -07a')
6L;A WkL)
BY
St Lucie County
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: It)
Site Address:
Permit Number: i 9 On — O)t,�Q
Auga Dlmenslons Plumbing State License CF665726 SLC License 16628
Original General Contractor (or Subcontractor)
One -Stop Plumbing Services, Inc. State License CFC1430061 SLC License
New General Contractor (or Subcontractor)
Reason for Change wrong contractor submitted
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 ar se -as -a result of this change of contractor/subcontractor or cancellation of
permit. A mi cmmot"c!Pgdif-wark has been performed.
SIGNATURE OFO r nerlbuilder) [ S OFNEWGENERAAL� ONTRACTOR
PRINT NAME PRa4TNAME JOXS -I Jlt^'rrr
State of Florida, County of St Lucie County State of Florida, County of St Lucie County
The Iollowing instrument was admowbedged before me this The following instrument was admowledged before me this
_,day or'�J(,nk.7�_, 2�, by & 2BJ]dayornrtohpr , 20M.by J ason James
tl is personaay know tome who is personally know to me
or wit has pmduc" , ,.` or ho has produced as m.
3 A J4&A, uy-i—
Signature of Notary Date Signat r oft ry Date
*Only signature required for change of subcontractor
Revised 07/21/14
*1sle!
Angelique Matlhe"
NOTARY PUBLIC
3TA7E OF FLORIDA
Comm# FF956412
Expires 21812020
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