HomeMy WebLinkAboutCHANGE OF CONTRACTORPlanning & Development Services
Building & Code Regulations Division
2300 Vi ginfn Avc.
Fort Pierce, -FL 34982.
(772)462 1553 Fix 462-1578
CHANGE'OT CONTRACTQR
Or Subcontractor or Cancellation of Perinit
Change of Contractor is to be completed by the property,owncr, 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 file 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 '(he• general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the.
owner and,qualifier of record: '
Date: 1P'%eq aO"to
Site Address: 01
Permit Number:
{ License (O� State License l / LC Licens
Origin�l ,General Conera_etor (Or.Subcontrac(or) l
State License&AWLC License�31(0 / _.
Ne1V General Contractor (o'Subcontractor)
Reason for'Change � � "—A
"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 t
any reason, which may arise as a resultof this change of contractor/subcontractor or cancellation of
peinut. A permit cannot be cancelled ifworlchas been performed.
CNATURE OF-ONNERa, �(oroiv 6/buildcr)
,PRINT NANEg /7O /7 ?Alz
State of Florida, County of St. Lucie County
Tile fol_lowin n 1q{cat was ackn tvlcd a b�flatte'me this
day0 V 2� by VIVA
1/ whe is personally know to me
or who. has producedy as 11)..
• SIGNATURE OF,NE//WAENERAL'COONNTTRRAACCTORR
PRINT NAMIE?lk�
State of Florida,: County of St. Lucie County
'n1�E7followingi t Fntwasack/n %vlcdgcd fore me this
2(Y"� by�
who is personally know to me
or ivho'has produced, as ID.
Signature of ^-•• - Sig n6inre o
ry" .a•- FRANCES DO2NZA 01�9��d•`FRANC;ES•DONZA
MY COhMSSiO4HFF014]0
e EXPIRESJuty2Z,20i7*on1Y ss [na EISu�
?, 0ofd0d ThiatblaryWbGc Un0ourleR
9ondeolMi Nolaq WRL UnEar+*ten.�
Revised 0� -