HomeMy WebLinkAboutChange of Contractor °� PL�A�NNIl�TG &�;DEVELUPMENT S�R�ICES
'' BUILDINCOU NT
G&'ZONINGD�VISIUN _ -
:. 2300 VIRGINIA AVFs
BORT PIERCE, L-3498
462-155 FAX 462 1578
CIANGE:OF.('CINTRACtI`CI-IL STIR[ [lN'I1AC'Tt1R,:( R.C`ANCF,T; :,A`TTC1N[IF'"PFRM'i"
PLEASE SET;EC> 'ONE OP THE bL-LbWING:
CHANGE QF CONTRACTQR Change of Contractor zs to be signed and nofarzzed bythe.property otxmer
and tine new contractor of`ecord for the current.peum A ne`. permit:appItcatron roust alio be con plefed wzth,.riew
contractor information a'r`id;signature A new Nnfzce of Commencement znust:.be filed in the new oontraciW& naive
for-}ob va nes= greater than $2500 ($7600 if AIC, Change-out) A:recorded copy must be stbmrtted;:pr or'to
c6irrnencang any,work There is a X50 Q0 fee for the Change OUP
XCHANGIt'<OF SUBCONTRACTOR—Subcontractor.changes are-to-be compietedby the general contractor:
The°new subcontractor.riiustfih out a Subcontractor Agreement Form. There:ig,a$50.00'feefor theChange.,of Soli-
Contractor::
CANCELTATIQN OF PERMIT The canceilatlon of;.a permit zs acceptable;only>f no work has been done;
CaiiceHit zdrl-of perinzt rs,;:ttt be.s>gned,and notarized by both'the owner and:qualzfze of reso d There is no.fee.fox
cancellation of the permit J
Date 8/5(20 Ferm><t Number..
S>ite:Address . r,: -- -
PEAYS ELECTRIC, State License ER120455; SLQUedme
QrigmaliCsubcontractq o>E ownerlbuil8er -
GOLDSTAR'':EIECT:INC _._StateLic'enseEG13002082 - SLC:License:.. �_
Nety GC;siibcoritractor"
Reason for Cancellation PEAYS ELECTRIC;s no long�f, lthese fobs:,_ _. _ __. _.__.__._. r._
Thgmndersigneddoes hereby agreeaa�ndemnify and hold Harmless St:.Caere County„its officers,agents and employees-from all`
co"sts�fees or-damages arrsrng;;from any anis`alt claims ofactiofi forany-reason,,whtch max-artse asta resulf of ibis change:-o£
contractorTs ` ontractor ancelIatron o f permitA,permit:cant b.' a c tleii if wo`rk Has 6.een performed:
_rider} y NA'.,- E[1g CgrWpTpk,(ornew GC,asap placable).;.
_
,PRINT NAME,B.nan 1n:Cavriar
State of Florida;County.of 5t LucieCounty .State of1Ionda,.Gowtty,of.St_;Luc�eGou.,nt}t'
T[ie:Poliovnn insttumetrtv��as aclaiowledgeil'l5eforemethis The'fulldwmg instrumentwas.ackn-M d--W befOre:metFiis
5 dayofAu9Ust-- 20�.bY - s _ _ dayof August °20 za
Bean W QaVICl90(1 wfiaiis persoi ally knotvnto'it e. John Cavnar
_
or whah as me or sed -
�
s
S�goatur4otriotary^ Date S�gaatnreotNotary Dafe:'
Re'v5ed 1)ltrAPL�NO g3564S
f.;RPYfRRINQ Y sjµYC4k►uSSloNtl�'
MYCONylSSIONFGG ptplRESFeOcuupda 'n;
83583
•as �,1+ IXPiRE3 Eebruary_27,2Q24�
° 6ordedlhru
..._. __ H�KPubitc_UnderwA6eri. .
7
PERMIT# � ISSUE;-DATE: �
.. .._... .._ .......
PFANMN
G&D0 W ENT SERVICES
E `Bui�dttg & Code CompLance Division.
BUILDINGrPER1VIIT
S;I)B-CONTRACTOlkA&RtE1V tN
Goldstar Electric=lnc slave agreed to be
;.(Company Name/Individual Naiie� "
, ahe�-_ . Etectiical� _ __ Sub coixtr"actor,`for -.-.D.R.,Hortori'>Inc:: .-.
(Type of Trade' (Primary Gontractor�
�', '.For the pro�ectlocated at . _.� .__ �o�t�•'. �/,1=� , i . �:; s..
ro ect S
(P J, treet Address:orProperty`lax=I #);
It is iinderstood`that;,if there;Is{,anycharige of staus regardingour partFctpaton withthe,abgve menttoned
pzo�ect the:`Building and,'Gode Reguidion Division of'St Lucie County wlIl_be advised pursgarA to the
;filing of a.Change::of Sub=contractor.notice:
,�- rJ
CONN T PA 9TEOIt P ftATURE( iklt_
PRINT NAR1E .. ..._.. PRINT NAM>'
ECL•3Q:(12QN,
OPpN!x&w--rWJ.6 Tl ' NUNIBERCOUNTY.=.CERTIFICATIONNU!VIBER
state oflj(orida,County af�revard :-__-: State of Floti'da,County otBievard
The foregoing instrument was signed before me flits j` .day of< the foregontg mstrnment was sigc►ed;belore me t}is Bay of
_.. August 20 20'lty Brian W:Davidson. Aueust.- ,7A 2Q6y:.. JoliriGavnar -_...
__..
tvhu�is personaUy known_Xor has produced ^- __ who�s persogally kii x,or.has produceda
� s
as idtntificahon asidentdieahon
- w
Signature ofNotAcy.Public ,�r� Signaturc of NataryPuhhc z
Dina'Painno __, �� x Dina Eariirio. �x�..
nnt,:eine oMotary ,u a ant. .ame'o, otacy ,u ile v
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;itev�sed I,t/16!'�QI6