Affidavit of Change of Engineer/Architect

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Affidavit of Change of Engineer/Architect

Project: ______________________________________________________________________________________
Permit No: ________________________ Job Address: _____________________________________________

Owner’s Information:
Name: _______________________________________________________________________________________
Address: _____________________________________________________________________________________
Phone Number: __________________________________ Email: ______________________________________

Current Engineer/Architect of Record Information:


Name: ________________________________________ License Number: ______________________________
Address: _____________________________________________________________________________________

New Engineer/Architect of Record Information:


Name: _______________________________________
License Number: _______________________________ Expiration Date: _______________________________
Address: _____________________________________________________________________________________
T.I.N.: _______________________________________ Email: _______________________________________

Thorough inspection performed by Engineer/Architect of record ( ) Yes, Dates _________ ( ) No.

I agree to hold the project ______________________________________________________________________


and relieve them from any responsibility and liability for the completion of resulting from substituting the design
professional. I furthermore assume responsibilities and corrections, if required for work performed under the permit for
which I am requesting substitution of the design professional. In the event that there have been a change of ownership
of the property/company, the new owner assume the responsibility for notifying the previous owner of his/ or her intent
to substitute the design professional. I am also certifying that I understand and full comply with the required standards,
requirements and codes regarding authorizing the re-use of plans from one professional to another.

___________________________ _______________________________________
New Architect/Engineer of Record Owner:
Date: ______________________ Date: ________________

SWORN to and subscribed before me this _____ day of ______________ , 2019, by _________________ ,
____ Personally known or ____ Produced I.D., Type of Identification Produced _______________________

________________________
Signature of Notary Public

(seal)

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