HomeMy WebLinkAboutChange of Contractor aY€I� L QD
R E C.
APR 0 5 2016
PER1U11TTING
Planning & Development Services St. Lucie County, FL
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: �/ 1 Permit Number: 6 L r 660 /
Site Address: 13 9 9 G ( w,
lid) 1 reoJi D,�,G, State License'CU 300M 7 SLC License 1�el�j 6-1
Original General Contractor(or Subcontractor)
State License SLC License
New General Contractor(orSubcontractor)
Reason for Change QPeJW t'5
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
permit. A permit cannot be cancelled if work has been performed.
C E 4-1
SIGNATURE OF OWNER (or owner/builder) *SIGNATURE OF NEW GENERAL CONTRACTOR
PRINT NAME Esti f,_,Q:6PRINT NAME—
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 day of ( 2011_p by
who is personally know to me who is personally know to me
or who has produced as ID. or wh hasp ced as ID.
Signature of Notary Date Signature of Notary Date
*Only signature required for change of subcontractor ;o��aYa�B; KAREN S. NIELSEN
Commission# FF 115637
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Revised 07/21/14 y Q`: My Commission Expires
�i June 12, 2018
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