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;��., nit». I.I,..yt��"�1_;;i•',.�rgtG,,,h 1' ytit; Planning&Development Services
z" Building&Code Regulations Division
2300 Virginia Ave.
Fort Pierce,FL 34982
_..,..._.._.._........._._................ (777)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,
signa}ure, and transfer fee. A new Notice of Commencement most be filed in the nevv contractor's
name; for,job values greater than $2„500 ($7,500 if A/C Change-out). A recorded cagy 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: Permit Number:
Site Address 174e4z I ri_ ,l�
6tw” Lir 9q r i-e Inc
nc State License Ct1L'051 V0 SLC License Y77
Original General Co tractor(or Subcontractor)
I
State LicenseSLC License_
,New General Contractor(or Subcontractor) r(
Reason for Change_ CUslomer cc-nee[lC?d
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 permit cannot be cancelled if work has been performed.
S(GNKrUREWNI;R (or owncr/buiiderr)),r $1GNATUREQFNEW GENGRALCONTtiACTOR
PAINT NAMS Cil !lf r/�'�� PR{NTNAM6
State of Florida,County or$t.Lucio County State Of Florida,County oi'$t Lucic County
'i•he following instrument was acknowledf d befom nuc this 'nue following instrument wns aeknowicdgcd beitim me this
f day Of C1 .2019,by _ day of_ 20_,hy_.
i�A�'. !,� /f�l _.
who is rmonsitv know to me / who is ptmonaily know to me
or n has pnid dZ__ag IQ. Yd or whohas profits cd ___as=� as it),
afltitrC of N ry wte Signature of Notary Date
. 7
*Only signature required for change of subcontractor
V
Ravissa 07/2i114
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