HomeMy WebLinkAboutCHANGE OF CONTRACTORRECEjvao APR 11 MS
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave. SCANNED
Fort Pierce, FL 34982 BY
(772)462-1553 Fax 462-1578 St. Lucie COUntl,
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 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: 3/25/2016
Site Address: 8630 S. US Hwy 1, Port St. Lucie, FL 34952
Great Dane Petroleum Contractors Inc
Original General Contractor (or Subcontractor)
Mulligan Constructors Inc.
Permit Number: 1501-0410
State License CGC1510462
New General Contractor (or Subcontractor)
Reason for Change n o t,1, p— &,k�g Pjl C c
SLC License
License
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
agents, d employees from all costs, fees, or damages arising from any and all claims of action for
any real n, which may arise as a result of this change of contractor/subcontractor or cancellation of
permit. permit cannot be cancelled if work has been perfo med.
SIGNATURE OF 0 ER (or owner/builder) ' SIG ATURE OF N GENERAL CONTRACTOR
PRINT NAME 1 C I TNAMEJa On Mulligan
effnio—
State offio4ein, County of &. 7 ic�calei
The following instrument was acknowledged cf re me this
]jjut�da�y^of (Y1DVCt1 ,20�5 by
1, M I lam whois ersonally know to
o ho.has produced as ID.
chi cdc,Qa�3/mil
Si nature of Notary Date
*Only signature
Revised 07/21/14 ROCKDALE COUNTY
STATE OF GEORGIA
My Commission Expires August 16, 2019
State of Florida, County of St. Lucie County
Thefollowinginstrument was acknowledged before me this
52 l day of MAr� , 20�, by SOri
NlulliQAr who is personally know to me
or who had oroducedZ_ _ O as to. / r
Date
JENNIEBACH
MY COMMISSION 8 FF 015857
EXPIRES: July 5,
2017
BcadedThNNOIary PuBn