HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
81�A
UANNED
St Lu By
c'e COunty
RECEIVL-,
Or Subcontractor or CancelIation of Permit
.RB 2 5 2as
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.
C,2. f-) r�
Date: c11_.? I
Permit Number:
Site Address:
vm_qh:�� State License SLC License &Z_�Y
Originaf General Contractor (or Subcontractor)
—State License SLC License
New General Contractor (or Subcontractor)
Reason for Change&VaZ� OF 7W " 7�2 VaIM5 Aq f
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.
7
SIGNATURE OF OWNER (or owner/builder) SIUNMIORMF NEW GENERAL CONTRACTOR
PRINT NAME PRINTNANIE
State of Florida, County of St. Lucie County
The following instrument was aclatowledged before me this
—day of _ 20— by —
is personally know to me
or who has produced as ID.
Signature otNotary Date
State of Florida, County of St. Lucie County
The following 1- e wasacknowledge'deforemetlis
n25- day o 120A, b
, rsomelIM
who is personall 0 me
or Zpuced
V
Signature of N44 ate
*Only signature required for change of subcontractor
Revised 07/21/14
110, 40J?Vl 3WIdX3
NOIS I IN03
MUMMIM'S ariv VO I D