G:\Zoning 2009\Forms and Sample documents\Website Documents\Building\Forms\change_sub.pdf Modified: 10.22.2012
City of Pompano Beach
Department of Development Services
Building Inspections Division
100 W. Atlantic Blvd Pompano Beach, FL 33060
Change of Sub-Contractor
Phone: 954.786.4670 Fax: 954.786.4677
Permit Number: _______________________________ Date: ___________________________
Job Address: ______________________________________________ Pompano Beach, FL _____________ (Zip Code)
________________________________________________________ _________________ __________________
Subdivision (If Acreage, attach legal description.) Block Lot(s)
Job Description: ___________________________________________________________________________________
_______________________________________________ _____________________________________________
Original Contractor Proposed New Contractor:
Florida Building Code
Broward County Amendments Chapter 1 - Administration
105.13.4 Upon request of the owner and/or permit holder and on investigation by the Building Official to determine that the work has been
abandoned or that the contractor is unable or unwilling to complete the contract a second permit may be issued where there is a change of contractor
without the initial permit being revoked or suspended.
105.13.4.1 The foregoing will be permitted only when the following stated persons have filed with the Building Official a letter stating the
reason for a second permit being required and holding the Building Official harmless from legal involvement. All interested parties shall be
notified before action is taken.
105.13.4.1-1 Where a sub-contractor or specialty contractor is the permit holder the owner or prime contractor shall both file such
hold - harmless letter.
Hold Harmless
BUILDING OFFICIAL:
As legal owner of the above mentioned property, and pursuant to the Florida Building Code Sec. 104.9.4.4, I request issuance of
second permit for the referenced project, for the following reasons:
___________________________________________
________________________________________________________________________________________
I HEREBY apply as owner, or authorize ________________________________________ to apply for such permits as are necessary
to construct or complete the construction on referenced property.
I agree to hold the City of Pompano Beach, its officers and employees harmless and to relieve the City, its officers and employees
from any responsibility or liability for any legal action or damage which may result from the issuance of a new permit. I further
acknowledge that as the owner, I am responsible for compliance with the code and any and all corrections, if required, of work
performed under the prior permit.
I, _______________________________________, the prime contractor on the referenced project, join in the owner's request for
issuance of a second permit to a sub-contractor or specialty contractor for the reasons set forth above. I further agree to hold the City
of Pompano Beach, its Officers and employees harmless and relieve the City, its Officers and employees from any responsibility or
liability for any legal action or damage which may result from the issuance of a new permit.
__________________________________________ __________________________________________
Owner Signature Prime Contractor Signature
STATE OF FLORIDA- COUNTY OF BROWARD STATE OF FLORIDA- COUNTY OF BROWARD
Sworn to (or affirmed) and subscribed before me this Sworn to (or affirmed) and subscribed before me this
______ day of ___________________, 20 _______ by ______ day of ____________________, 20 _______ by
__________________________________________. _________________________________________.
Type/ Print Owner's Name Type/ Print Prime Contractor's Name
___________________________________________________ __________________________________________________
NOTARY (print or stamp) as to Owner or Agent (Signature) NOTARY (print or stamp) as to Owner or Agent (Signature)
Name & Title ______________________________________ Name & Title ______________________________________
Personally Know ___ OR Produced Identification _____ Personally Know ___ OR Produced Identification _____
Type of Identification Produced _________________________ Type of Identification Produced ________________________
