HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
SCANNED
Building & Code Regulations Division
By
2300 Virginia Ave.
St Lude Coimr,
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or CanceIlation 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 — / -5-- /z,
Site Address:
Permit Number: /52�79— Olc9fio
ISQ-e /% f /�: 5 State License e!) J ?0'3 SLC License
Original General Contractor (or Subcontractor)
State License
General Contractor (or Subcontractor)
SLC License
Reason for Chanve A- e, C , �qo J� Afil �, � '. I � /)�_ �, � J
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,-, I —
SIGNATURE OF OWNER (or owner/builder)
PRINT
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
ay of . 20— by_
is personally know to me
or who has Produced 011).
Signature of Notary Date
State of Florida, County of St. Lucie County
Signature
*Only signature required for change of subcontractor
Date
before me this
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Revised 07/21/14 1*& N -�WkLA M HUFF—"
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