HomeMy WebLinkAboutChange of Contractor 77 7Z ZZY- 7EtC-7
Planning &Development Services
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: Permit Number: '51...r-
Site Address: H F,5T SQa rS 5V 1 �o C k VleY C e_r P L, Z'-i ci%1
ml6\6\g- State License L SLC License C c-,C 15 1 S -S
Original General Contractor(or Subcontractor)
PAy,%io'n5Z L&yvy anekl� State License PL SLC License CRC Ob b9
New 6eneral Contractor(or Subcontractor)
Reason for Change Qi t2\\'�-A Lf' Re+\-Ced- Wf 2gd -VD vzSS �Vn-ok
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.
SIGNATURE OF O ER (or owner/but ) *SIGNATURE OF NEW GENERAL CONTRACTOR f� dr
PRINT NAME PRINT NAME Af)0110,V56-- C*ml �e
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 OC A6 er ,20E by�CN r /t i PiY day of aCID,4 el- ,20_/Cby6�t okst-
i1'Yi1 Z who is personally know to me �a a.-e//' who is personally know tome
or who has produced as ID. or who has produceedd/ as ID.
Signature of Nota Signature of Notary Date
�pma-
Revis
'Victoria Lee MtI
NOTARY PUBLIC `' Y Victoria Lee Murrell
*On ` 31C1SIe�t1DP� for change of subcontr.� o gNOTARYPUBLIC
aComm#FF177686 c STATE OF FLORIDA
Comm#FF177686
Expires 11/18/2018 ���cE1�1� Expires 11/18/2018