HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
SCANNED
Ea BY
St. Lucie County
CHANGE OF JUN 0 920
Or Subcontractor Cancellation 0 ermit at. Ucie C7TING
�o°oh', F4
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.
f kJOT k cts�_
Date: (ID 115 Permit Number: t0
Site Address: C 75-1 �) t ':Z) . oQ�i bQ. .
Q}}S 11QI`i l(v,'iiC.t State License; 5%LCLicense
Original General Contractor (or Subcontractor) -13
State License SLC License
New General Contractor (or Subcontractor) *1�
Reason for Change
M
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
agents, and employees from all costs, fees, or damages ansin from ally and all claims of action for
any reason, which may arise as a result of this change of con ctoz/subcontractor or cancellation of
permit. A permit cannot be cancelled if work has been perfor d
SIGNATURE OF OWNER (or ownerftilder) t SIGNATURE OF NEW
-,oG,E`-1 j` GENERAL CONTRACTOR
{�
PRINT NAME PRINTNAN W 1Jlacl4 d(' s
State of Florida, Couaty;of St. Lucie County
The following iaskumer¢was acknowledged before me true
—day of 20� try
who is personally Imowto me
orwho has produced as W.
Signature of Notary : Date
*only signature required for change of
Revised 07/21/14 '
State of Florida, County of St Lucie County
Thefollowing
tioteturm�em was acknowledged before me this
�Ceii Ht3lP1Ab5 whoi naliylmowme
a has prod 91 � �O 11'�7�1J'C
Signature of Notary Date
subcontracto 3 s ANISSAC.OVERSfREET
. ANISSAsicn#EE166536
' Expires June 6, 2016
aeMaEmutlorF®I neiemwal0Nmjq
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
1
�y SCANNED
(04CjG St- Lucie County
F
O�G
810
J'
CHANGE OF
Or Subcontractor Cancellation o ermit
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 (S7,500 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. I U a
c
Date:
Nd
Permit Number: -LO
Site Address: L`� gn �jC:Z—)
State License !��%LC License
Original General Contractor (or Subcontractor) IQ
State License SLC License
New General Contractor (or Subcontractor)
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 arisin from any and all claims of action for
any reason, which may arise as a result of this change of con ctor/subcontractor or cancellation of
permit. A permit cannot be cancelled if work has been perfo d
SIGNATUREOFowNER (or owtu/budder) "SIGNAf=OF NEW
11aaG,,EyNEERAL{CONTRACrO�(Rp
PRINT NAME PRINTNAW 5c.> 1 ` V �oi' ' W
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie Coutdy
The following instrument was aclmowledged before methis
day of .20� by
is personally know to me
or who has produced aSID.
Signature of Notary Date
*Only signature requixed for change of
Revised 07/21/14 Q` OAe
The following tigstrumment was acknowledged before me this
1 day of —mot w.� 2015 by
Gii HOl S who' personalty know me
gg�ho has produced as ED
Signature of Notary Date
subcontiacto 3 's ANISSAC.OVERSTREEr
• a Commission # EE 166536
r Expires June 6, 2016
•• (1®ddtivu4gFabNaFenmwo'W010
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