1. The
Owner
Tenant/ Lessee
Construction Services Division
1400 N. Boulevard
Tampa, FL 33607
Phone:(813) 274-3100
Fax: (813) 259-1712
www.tampagov.net/permits
Change of Contractor
Acknowledgement
Job Site Address:
Existing Permit Holder:
New Permit Holder:
Section 1
Section 3Section 4
I,
do hereby state I am the bona fide
of the site address and as such:
* Have the authority to initiate the Change of Contractor
* Agree to the conditions as prescribed in the Change of Contractor Acknowledgement
License Nbr
License Nbr
Contractor
o
n project of said PROPERTY, his heirs, assigns and successors in
Owner
Contractor
Owner
Owner
Tenant/ Lessee Contractor Print Name Signature
Instructions: Please utilize this form if you are:
A) A property Owner (residential or commercial) or tenant/ lessee (of a commercial space) changing the existing
primary contractor on a permit (existing permit holder) to a new primary contractor (new permit holder) or;
B) the existing primary contractor on a permit changing an existing subcontractor (existing permit holder) to a new
subcontractor (new permit holder) or;
C) the existing primary contractor on a permit (existing permit holder) changing responsibility of the permit over to
a qualified Owner Builder (new permit holder).
Section 2
New Permit Holder Name
Date
I,
being the bona fide
Owner Tenant/ Lessee Contractor
of the property located above, hereby request the Change of Contractor as indicated above. I hereby certify that
the existing permit holder has been notified of the request for the Change of Contractor, and that all other
aspects of the project remain unaltered.
Now, therefore, the
Owner
Tenant/ Lessee
Contractor
in consideration of the Change of Contractor
for certain work at the above address, hereinafter referred to as the "PROPERTY", does hereby agree as follows:
interest, waive, renounce, relinquish, absolve, and discharge the City of Tampa from any and all liability for personal
injury and property damage which may result from the Change of Contractor for certain work on the PROPERTY
even if the Change of Contractor for certain work on the property is later found to be wrongful or negligent.
2. That
Owner
Tenant/ Lessee
Contractor
shall defend, hold harmless and indemnify the City of
Tampa from and against all liability, loss, claims, damages, cost, attorneys, attorneys' fees and expenses of whatever
kind or nature
which the City of Tampa may sustain, suffer, or incur or be required to pay by reason of the Change
of Contractor for
certain work on the property even if the Change of Contractor for certain work on the property is
later found to be wrongful or negligent.
Tenant/Lessee
Contractor
Signature
Date
Record ID:
Definitions: The term Residential, as used within this document, shall be understood to mean: Any single family
or two-family structure.
The term Commercial, as used within this document, shall be understood to mean: Any structure containing 3 or
more dwelling units (such as a triplex or quad-plex), apartment building, condominium, or other commercial
structure including, but not limited to office buildings, office high rise buildings, retail stores, grocery stores, etc.
Last Revised: 10-18-19
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