HomeMy WebLinkAboutChange of Contractor - ,
PLAN&,D�vELOPME;NT U, �ICS`
' BUILbING +&: OMNG:DT I TON
COUNTY 1; .
�3qa VIRGINIA ANE:
0
FORT PIRGE;FL 34982
(772) 462°4553 FAX 4. 2 1578
ri#'AN�-OF CONTRACTOR.SUBCONTRAGTOR��OIt.�ANGELL,�TION OF PERM'f'
PLEASE SEI;-ECT ONE OF'THE'EOLLOWII�tG:
CHANGE OF CONTRACTOR Change of Contractor IS to:be signed and notarize"d by the. roperty owner;
and`the;new contractor of record;for the current permit _A new..'pertnit;application mu"st-also be catngteted Ath ries
contractor information and signature A<new Notice of Commencement must.be°filed in;the new'eontractor's panne"
for job values greater thuri $2,500 ($7,500 if A/C 01iange outs A recoraw must, submitted=pnar to
coinnencing any`work Tlere.>ta,S50,a0 fee for:;the C;bange ofContractor .
X• CHAN
GE OE SUBCONTRACTOR Suhconfxactor changes are to tie completed by the general:contractor
The,new stz6contractar must f li out a subcontractor Ag%eerrlent Form TTiere,is n X50 00 fee for the Chenge o>>?Sulu
_- ..
Contractor;
CANCEI:IATIOI OF'PERMIT The cancellafton of a permit is acceptable_'only ifno worlchas been doiae:
Cancellation of°petmtt isi fo be:signeii and nafarized b botlrtfie:owner and gualif er of:record.,TIiere A's no fee<,for"
ca>acellahori,of the permit _
Date- 81§49 _. _ _ . _ _ Permit Number,
__...
_
PEAYSt E!ECTRIG_ ___. State License ER��045 ;- _ SLC
-. :. .:
Ornal GC;subcontractor or ow le-it.iuilder
State License _ . _ -_- SLC-Iicense -- .
New_GC,,stbcdntraetor�
Reason for.Cancellation pEAYS ELECTRIC is<no,longer on these iobs;_ . __ __-
Theundersigned,does herebyaagree to tndetinify and hold harihless stLucie Count ,'ita oicers,agents and employeesfrom al(
costs,fees or°damages arlsing ffoinany.and-all claims.. f actiait for anyreason,;which:may arse as a result of th�change of
contactor/s ontcactor ancellation of permit A-permit can t 6 a ed i#iYork has lieen performed.,
c i derX A_:. `-ENERAL CONTRACTOR(oF now G_C,asagplteabN
P,RIIdTt:NAME BCIa[t IIV D- 01§66 PRAVTNAb1E J011n.:CaVnBr:•'
$fad of Flonifa;County of StI uci_e,,ounty Sfate,of Flonda bounty of St,.LucteCourily:
The;folloanng�nstrumencwas acknowicdged,6eforeme this before methis:.
da of �0
5— dgYofAUgust . _�Q20 •.61._ .,._ Y 1iY
Brian W.;dBVI[iSl)n wfio,i`s_ eisonall'knownto.+me. _',f6hn C aVnar _ w
or-whaha `�:. me or `red ?as
Signature of.Nota'ry. Date S�nBtare of Nota Date,
ed DI
Revs NARIND
..r iay coiwasstaela
- .a�r7Z' lb.. DIhtAPARR►NO, r ��{.., ��$.P6bN9rl.u��ti.
NY COMIdISSION f cr3 sansei TtoUxf
-
8ondodih uN0
- UMct�rlfers" ...
- alk
,`PERMIT# JSSUE;DA
PLA,lTIP�tG & DEVELQP�IZE1'�T-SERVIC
��` � � � Build><ng & Codi��omphance I�ivsiou
•COU
B'UnGvWcIP'ERMW
-__ _e_.__.,..._� S.UB-CCENTRCTbIt:AGREElV1El�TT
Goldstar=EIectric Inc S ave agreed for be
,(Company'N�me/Indtyi�ual Name) `"
the".—__ Electrieal _ 916-co -f6 ..k,;Mr
.
(Type.ofTrade) - (PrunaryContractor)
Forthe ro'eet Located
(Pro}ectStreet.Addres"s ar PrQpe. TaftID#}
It Is-.understood that,if there-Is ail--change of status regarding our panic o tion�vitliathe above 'mentioned
project th Btiilding and.0 odalCegulation,Division.of St.Lucie County will;.be.advised°.plarsuarit to the
filing of a Change=of Sub=contractor notice.
COIVTRAGTOR SIGNATURE( uaUfier� - 5UB RAC „` GNATUI2E(QuaLfier}r
Brlan`W Davtdson Jahn'Cavnar _
PlrlVT NAME t _ :.. .. RRINT NAME'
CRC13270`68 Lal- 602082
GOtiJ�IT,Y'GERTIFI�ATION,h'i3�NBER, ' -` • COUYTX CERT[FICATIONl'I�UlNSER` "`""' -'_
State of Flonda,;Coynty nf.. r
Brevard state o[Elonda,Cnunty oiBr.'evard;
TkgxAreggang ihs"Oot,was signed before me t6js 5._day of TF►t foregaiog rnsttument�vas signed 6efore,methis 5 day of
August ;20 20 bg Bian W.':D'avtd"son Ausust' 20 20'br Jolm Cavnar
whg u Personally,_kugwn x,orhas prgduced a _.. . ._ Per;onall kngwn�i Qrhas;.roduceda" - -
who
as identification. as-identcahon
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v .
&lnatnreotNata Public Signatareo(Notary_Pubfic;. " " �flax 5
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-rent ame o, ott+ Sal
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