HomeMy WebLinkAboutCHANGE OF CONTRACTORJan 10 18 08:10p JMS
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BY
Planning &Development Services
St. Lu e County
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, Fl, 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor 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 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: <.' � , �) c1.• Cl Permit Number: S L C 1 6s' 00 L/S
Site Address:
�f �l-SfPi 1' CAC c0 C n� / ( . i� i 's^ State License ! .3 �SLC License
Original General Contractor (or Subcontractor?
,a SS /7'-1 EG',a-(,4 ti/C ri t_. State License ('01SLC License3 U `H-L
New General Contractor (or Subcontractor) / Z.5 V Z I S
Reason for Change 6,r i el,- fze t u r try E r t I
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its otticets,
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 mmer/builder) •SIGNA tIRfrOF NEW GEMERALCONTRAuroR
PRINT NAME PRINTNAME _�C E✓ /y ✓�/"//YJ y_
State of Florida, County or St. Lucie County state of Flbnda: County orst Lucie County
The following instrument was acknowledged before me this Thu following instrument was acknowledged before me this
_day of_ 20_, by _ y of Sail , 20 i01 by V i V t,
who is personal ly know to me (who is perwnully know to m ,
or who has produced as To. or wtt has produced as In.
� �Gn-Yt_�^e�.t?u4-eCCkni�
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Signature of Notary Data signatvra of Notary /t)Date
- - -*Only signature required for change of subcontractor
Revised 07/21/19 % KlJEPYJOCSH
MY P MMISSION a FF921100
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