HomeMy WebLinkAboutCHANGE OF CONTRACTOR08/30/2015 21:06 FAX
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Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34932
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Permit
SCANNED
St. Lucie County
Change of Contractor is to be completed by the property owner, and the new contractor of record for the
current permit. A new pennit 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 yob values greater dean S2,500 (S7,500 if A/C Change -out). A recorded copy must be
submitted prior to commencing; any avork. 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:
Site Address:
Permit Number: — 0-11 L L
A.C. ', = !>S x s?.�1: .c, l 2 LLLState License L� (. Lr, ni�F6'Z SLC License
Original General Contractor (or Subcontractor)
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, land 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 per>rmt.caramait be c ))died if work has been performed.
PRINT
State ofFlerid::, County of St. Lucie County
The following instrument Baas acknowledged before ne this
. day of C; —.20 is by
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is personally know to we
or who has -:rgduced as 11).
Signature ofNatary Date
*Only signature at;,:t, `'—'"
41 "a a JONNNIE
Revised C7/2r/i4 FELIX a < Notary Public.
htY Con State Of Florida
m. Expiros Feb 28, 201;
Commission *' EE 879048
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SIGNATURE OF NEW GENERAL CONTRACTOR
PRINT NAME
State ofFiorida, County of St. Lucie County
The followng instrument was acknowledged before we this
_,_,day of , 20l, by_
is personally knew to tiro
or who has produced _ m ID.
Signature of Notary Date
rac_or