HomeMy WebLinkAboutChange of Contractor � tJ
i
Planning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
o M T1 Fort Pierce,FL 34982 u
'- (772)462-1553 Fax 462-1578 Vol mum
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellati moffPeYit=nrX!
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: 12/22/15 Permit tuber: SLC1511-0120
Site Address: 6872 BRONTE CIR AkV
RICHARD LEVINSON , at ense CAC014619 SLC License
Original General Contractor(or Subcontractor)
State License SLC License
New General Contractor(or Subcontractor)
WORK WAS NOT DONE.APPLY FOR IN ERROR
Reason for Change \ i
f
The undersigned does hereby agree to indemnify n hold ess St. Lucie"County, its officers,
agents, and employees from all costs, fees, or damWre
y and all claims of action for
any reason, which may arise as a result of this thacontractor or cancellation of
permit. A permit cannot be cancelled if work has be
j.
SIGNATURE OF OWNER (or owner/builder) tm SIG''s !k50JP E�J GEN�fi )>E CO i ACTOR
PRINT NAME PRINTNAME RICHARD;'LEVINSON
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State of Florida,County of St.Lucie County State of Florida,County of St.Lucie(County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
day of 20_,by ,ay of 1 15IIj.by RICHARD LEVNOSNON
who is personally know to me ersonally know to me
or who has Lrodas ID. or who has p odu d as D.Mot
° ... .
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,grltu :(Votary Date Si na a of No Date G ' ::v 3
*Only signature required for change of s, cc tractor
Revised 07/21/14 -
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JESSICA DOTSON
;;c`•'"`'P���'%' �FF072984i' �j _ v.ti��,
- ' - EXPIRES:November 25, �.
�'rT oe� Bonded Thru Notary F'uhlic Underwrites s _ 1