HomeMy WebLinkAboutCHANGE OF CONTRACTOR' planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578 SCAN
BY
CHANGE OF CONTRACTOR St. Lucie c
Or su contractor 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 tiled in the new contractor's
name for job value's 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. Any cancellation of permit must be executed by the owner or qualifier of record.
Date: f, It r / /
Permit Number: ! SD 2— 0 0.9 9
Site Address 6 2 5-1 IV U 5 2
G State License C13L 12 S yds9 SLC License
Original General Contractor (or Subcontractor)
IM t; - t-t,o ` of State License C� C /5Y 5Sf o SLC License 2 937o
New General Contractor (or Subcontractor)
Reason for
S
d ne unclerslgned 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.
PRINT
State of Florida, County of St Lucie County
Thefoao twasacknowledged before me_this
�S dayof'SU 20_I&byCor}'t5
or who
Signature of Notary Date
*Only signature required for change of
• SIGNA • OFNEW G I CONTRACTOR
PMT NAME Cfllh{S 1'L C(t l,�
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
1S dayofgjl pp�by Cor-tS
who is personallykmow to me
who fibs produced FL •p ` m ID.
�,q,(I S
SignatureofNdtary Date
• DEANNA GIVENB
MCI%
tlolaty ppD11e - SlapeclFIoZ0contractor 1 as
AMY ccmnded tntou9n National Nolary