CHANGE OF CONTRACTOR
6/17/2020 Town of Fort Myers Beach
2523 Estero Blvd Fort Myers Beach, Florida 33931
Phone: 239-765-0202 Fax: 239-765-0591
Submit Original notarized form, $50.00 fee and New recorded Notice of Commencement
Permit No. Project Address
Job Description
Name of Owner Phone
As the legal owner of property listed above, I request a change of contractor removing
Original Contractor Phone
Reason for change
And appoint the following as the contractor of record
Contractor: License No.
Company Name: Phone
Contractor Address:
Contact Person: Email:
I agree to hold the building official and the
own of Fort Myers Beach harmless and
relieve them from any responsibility and/or
liability for any legal action of damage
resulting from the Change of Contractor
requested above.
Signature of Property Owner
Notary for Owner Signature
STATE OF __________
COUNTY OF ________________
Subscribed and sworn to (or affirmed) before
me this _____________ day of _____________________,
20_______, by
(SEAL) Notary Public Signature
_____ Personally Known
_____ Produced Identification
I agree to accept full responsibility for the
above reference permitted project, including
all previously completed work and to hold the
building official and the Town of Fort Myers
Beach harmless and relieve them from any
from any responsibility and/or liability for
any legal action of damage resulting from
work performed by previous contractors.
Signature of License Holder
Notary for Contractor Signature
STATE OF __________
COUNTY OF ________________
Subscribed and sworn to (or affirmed) before
me this _____________ day of _____________________,
20_______, by
(SEAL) Notary Public Signature
_____ Personally Known
_____ Produced Identification
