HomeMy WebLinkAboutChange of Contractorlgv1-0�1-V
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION P
2300 VIRGINIA AVE ��,� " ✓� m2�o
FORT PIERCE, FL 34982 °
(772) 462-1553 FAX 462-1578 °Q�a
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CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. 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 work. There is a $50.00 fee for the Change of Contractor.
x CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 1 I Q I202 O
Permit Number: Igob - 02u I
Site Address:3noo t)ert1 -DInQ 1T
F I eG+r i e iomne-c `on State License SLC License Z tus S
Original GC, subcontractor or owner/builder
AC- QuU1A!s1 Fle—Mi c State License SLCLicenseCG 1300y126
New GC, subcontractor
Reason for Cancellation Ro MMC,( uMfti nG r-6Y AV —AL 6 ft Hibrl- S �P
The undersignel does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fror
costs, fees or da ages arising front any and all claims of action for any reason, %hich may arise as a result of this change of
1tr contractor/subc or or cancellation of permit. A permit cannot be cancel[ if work has been performed.
PRINT
State of Florida, County of St. Lucie County
(The following instrument was acknowledged before �m�e�this
q ! t•dayof 20wW ,by lt 11 )
i,m rt"i l f Y who is personally known to me
or who has produced as to.
.A- V—t-AAA.tn/ I'Zi/Ib2,0
Signature of Notary UDate
State
Lucie County
(or new GC, as applicable)
.The folloawyinogtrument ins acknow edged befreGs 1 2m44 idIeii who is personallylnowu to
me or who has produced — as ID.
,4 - UAAA wY l lR12mo
Signature of Notary J Date
Revised 04/15/16
COMMAG
11,1 PkW 22, 2W
QBmlded Thu Aeloo
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SOW-
Mimi C. Kelleyy
,x Comm.9GG9249f0
PERMIT# I t/)O5 _O"ZL1I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
AC Quality Electric have agreed to be
(Company Name/Individual Name)
.the. Electrical Sub -contractor for GRBK GHO Homes LLC
(Type of Trade) (Primary Contractor)
F& the project located at cBen} 'P1r\-c Dr.
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
tiling of a Change of Sy b-contractor notice.
William Handler/GMBK/GHO Homes LLC
State = CBC051145
COUNTY CERTIFICATION NUMBER
State ofFlorlda, County of St Lucie
Tile foregoing Instrument Iras signed before me Ihis`'f t_s day of
LA-'U071 by William Handler
Z _
whopersonally known ]�Sur has preauced u -
STAMP
as Rebecca
h$ GG9, 20 6
E%Pltes: JvWait owl GBtaN
Bonded tltN
Rcviscd 111162016
sUB•CONTRACT RSIG RE (Qunillicr)
(nctVlt (Z' GouYLC
PRINT NAME) -
(--- C )300�1�8
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument Iras signedbeforeme tshi^�sday of
�( t tCy.-'ezi by��S-ftf j c
who Is persunally known --A has produced a
MY
STAMP
9StLuciel St. Lucie County
2300 Virginia Avenur
Fort Pierce, FL 34982
Date Invoice Reference
__________ __________________ -------- _________
09002 GRBK GHO Homes, L.L.C.
01/09/20 MN-264 Sub Change 090120,0264
A Remittance
GRBK GHO Homes, L.L.C.
09002
09.02-00011563
Jan 10, 2020 $50.00
Seacoast National Bank
0670051584487129890
Payment Amt Retention Discount Total Payment
........... ............. ............. ................
50.00 0.00 0.00 50.00
----- ------------- ------------- ----------------
50.00 0.00 .00 50.00
9StLuciel
St. Lucie County
GRBK GHO Homes, L.L.C.
2300 Virginia Avenur
Check
Number 09.02-00011563
Fort Pierce, FL 34982
Check
Date Jan 10, 2020
t
Date
_____
Invoice Reference
______________________________________________________
Payment Amt
________________ _____________
Retention Discount Total Payment
_____________ ________________
09002 GRBK
GHO Homes, L.L.C.
01/09/20
MN-264 Sub Change 090120,0264
50.00
0.00 0.00 50.00
Total Remittance
---------------- -------------
50.00
------------- ---------------�
0.00 .00 50.00