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Building& Code Regulations Division MIRECENED
d 2300 Virginia Ave.
• - Cort Pierce,FL 34982 Ap
(772)162-1553 Fitz 4624578 JAN 0 5 2017
CHANGE OF CONT OR
Or Subcontractor of aneellation of Permit
Change of Contractor is to be completed by the property owner, and the new contractor or 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 worlL 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 qual icer of record.
Date: ._.— Permit Number:_M Q :CDQ(-0
Site Address-'R 0 a � �("(p�� ``J� -�I-9Q a
1.�d tale l,icenseL�► IL, License
Original General Contractor(or Sub retractor)
-`State License SLC License
New General Contractor(or.Subcontractor)
Reason for Change -N -V
The undersigned does hereby agree to indeninfirand hold harmless St, l.ueie County, its officers,
agents, and employees from all costs,fees,or damages arising from any and all claims of action for
a reason,which may arise as a Vsult of this change of contractor/subcontractor or cancellation of
pe i it. A permit cell if work has en performed.
?,1Q. R 01:. "SIGNATURI:OP NNI Gt:NLRALCONrrPAC70R
PRia AAF C� � ~'Otil�vv��� PRIN'rNAM'
State of Florida.County of't.Lucie County lJ state or Florida.County oPSt.Lucie County
'(710 following instrument%suis acknox-ded\ 1f ged-before me this The fbllowir� stru
instrument etas acknowled_ged bcibro ane this
day of Hca.h� day of
�vhn is sAnnt tro��to - who is personally know to nic
u rh hus produc:cd as ll). or who hwj prvduccd �as(p.
��� 1-3-1^7 •
.l'unature o NlotAn' Date Signulure of Nntary Date
*Only signature e r i for Change of subcontractor
�.0 a4v
Revised 07/21114 _�ro0,0'ae�i JERALYNNE RUSSELL '
* _ Notary Public-Stato of Florida
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