HomeMy WebLinkAboutCHANGE OF CONTRACTORRECEIVED
Planning & Development Services
OCT 19 2017
Building & Code Regulations Division
PERMITTING
2300 Virginia Ave.
Fort Pierce, FL 34982
St. Lucie County, FL
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
JAB ED
Or Subcontractor or Cancellation of Permit
3t. LUCIe COUnfV
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: !D (11 10 Permit Number: l Loa s - () q d`f
rr` Site Address:_Ptloea S_ 0cto-,, Pij �cr,au 1� J 1 t 3`b'ir?
e
JU1S �+
State License SLC License
-D6Original
Contractor (or Subcontractor)
K.AkX _ d� o%_%(� 7�,J, State License O 2_, SLC License
New General C6mractor (or Subcontractor)
Reason for Change
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
pe it. A permit cannot be cancelled if work has been performed.
1712 D CfiM1LNER (or owner/builder), ^ * SIGNATURE OFF NEW GENERAL CONTRACTOR
is uAA :1F5Qf %2 515cclCivf! 0 PRINT NAIv1E (,t/,
State of Florida, County of St. Lucie Co'tinty1~ State of Florida, County of St. Lucie County
ti
ged before me this The following i at was acknowledged before me this
The following instrument was acknowl�
day of , 201'.�r1:'by I �l day of 20,L, by (,U I I i Rm
who is personally know to me T who is
is personally know to me
or wh has produced m as . or who U prod as to.
Signature of Notary Date Signature of Notary Date
KAREN S. NIELSEN
*Only signature required for change of subcontractor Commission N FF 115637
My Commission Expires
Revised 07/21/19 June 12. 2018
• «,,y KENO=. O. N108At1
Notay Pubk - Side o1 ilaldit
"c Commitilati'f FF 210340
My Comm. EWM At 05, 2011111
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