HomeMy WebLinkAboutChange of Contractor PLALvl�iING,Vic:DEVELOPMENT AIR 099--.
v- Bi3ILDING & ONIN BIVISTON
COUNT
230 VIRGZNL AYE -
o PIERC997.:
(772)4f2'1553' FAX 462 157$ "
CAAN(TE OF CONT ACTOR 4TRCONTRACTdR QR CANCELLATION OFPERMIVT'1'
PLEASES)LECT°ONE'CTHE
9FOLLOWING:
,.:_ ..r.
CHANGE OF.CONT R CT_OR= .Change.,of.,,Contractorls:toybe,:signed nd3ilotarizecl by,•the property owi ers,
and the new contractor of record for the current permit. A new permit application:must also;be completed wltllsnew:
contractor information and'i-J4 attire A view Notice of Commencement must be filed:in the new eoirtractor's name.
for fob values greater than $2;5.00>($7 500 If A/C Chang& ui A.recorded cagy must: be .submitted.;pnoi`to
commencing any.work'T>ere is a$ 0 0b fee for the Change of Coutractor.
_X- CHASjGE._OF SUBGQNTRACT4R-,Subcontractor changes,.are to be colrlpleted,,by,thegenerat contractor. '-
_
The`new subcontractax rriiist fallout a Subcontraefor Agreement Form;:There is a 554,00 ft e:for the:Change:of Subs
CO'it actor::
CAN kuATION OF PERNIIT The-cancellation.of'a permit is,_acceptable.:only if no werk:has been d'bm
Cancellation of penrut is;to be s gn-d.and notari?ed'by-both the b�vzie and;quahf'ier of ;T
Tlie_re is no fee for'
cancellation of the'pe M,
ba't6z, S/5/z0 Permifi Number � � �
SiteAddress} -L•CX cO Wear.
PEAYS ELECTRIC
State;LicenseER120455 ;SLC License=es
Ortgmal GC,subcontractor or owner/bu>lder
GOLDSTNR9LECT,INC State:License'EG13662662' SLCLieensa.
New GC,subcontractor x ...
Reason forC�ncella#ton PEAYS,EfEGTRIC:,istno longer on these lob's:, ,
Theundersigned does herebyagree fn Indemnify and:hold hartrtless St.Luete County,it"s officers,agents'attd employees from all
costs;fees or damages ar�stng'from any and all clatms'of action for any reason;which;may anse=as a result of;this charige_of
contractorls ontractor an�e]lation,of permrt A-permit can t bv_ a ed d wark•has Leen perforuteilr:
r
cr� CON
GNA s `:. .TRACTOR.(or.neivGC a$a ieable)
SI _#ld
PRINT. NAME.SnaFls�lS/,DaV.IC�San=_- PRINTNAME JOhnCaVOar :-::.
$tate of Florida Countyof StsLucie County Stateof°Flanda.G.tiunty of St;Lucle,CQunty
The:`foilowmgnstunscn@�vas;acknowledged`6e6reme this: The• dged before rise thas;
-: : f AU USt: 5 Clay o€ ;AiKjusE ?0:20.by
da:vf 9 2020 by :_.
.,. �- •z. Yom- - . - _- - -
Brian W .Davidson ,-t,
- wih4�s personallY-knowilto'me; �Of1f1 Ci3V�ar .._- •,
Signafare of lYotaig Aafg Signature ofNof 0 Date
Reyssea OINA
PAR�ND"
if V. DIVA ppMNO; a,r•� t (COMNISS10N 1> g2
Fahsuar1�27
e,
A(Y COMMISSION If GG 935643 °' E?CP pyy} Unean^`»
:.;7
EXPIRES F'ebma
o
said�r'"'
-
Bonded,TlwNotur,P�CBUade .
Fes+ •
.r
t •.i e .
.� - FL�fi1`�N�T�&DE't�ELOPMENT`SE1tyIC`E
Building & Cade,C ;4 :'fi e"DI, Sion
' COUNTY
t .
j
BU)iLDING PERIVIIT -
5tI CONTRACTOR AGREE3�IEIVT
LL - Goldstar..Etoatte"Inc _ __ -_ -. . have_a9, V. to g
_ .
(Company.°Namejndif.V
the: Electrical _. - -<- -, :: .,, Sub ct7ntractorfor .I).R._Horton Iric _
. _ _. . . _
{Type.of.'Trade) (1'cimary Connor
p JUri - q` ar X771
For the_ p eccated a
(ProjeI reet Addtes`s�or Properc)LTax-ID#1
It Is understood that,,'tf the :Is anyy change of status regarding our partlelpat on with the abovre n entloned
project;the Butldmg and Code Regulapon Division,o S Lucie Gourity wi11,6e advsed_pursuantto the
filing:of a Change of Sub contractor notice
.!") %,
CONI R-S1 NATURE(, —61
;,Arian W,Datvfdsori Tohn Gaynar. __--
PRINTNANIE PRINT NAME'
CRC232706$ EC-0902'0'82
COUNTY`CERTIFIGFATION NIUM'Ek. COUNTYCERTItICATI0y 19UMBER` _..::__..___:.
State of Florida,County otTeVard'. 5tatc of Florida,County of Brevard
'Lfie foregoing instrymeat was:staded pntore mgAthis 5' day.of Ttie forego ug in3_trumenf was 3i;ned tie'Iore meitiis', s aa}_of
- Brian D'av
W` tdson_ Art ust ,zo 20,by . .John Cavnar._._
August: zo 20,by -
who!s,-perBanally'. owo x-,or has produced a - who r9 pe`rsoiialfp&aown x ar.°^has produeeda
as ideat�ficahon as:iileah6cation _
$� atare;ofNota `Public, z Z SiriatuitofNota Public
Dma Pamno ,,,z i Ama Perrino ;
,4nt-Namepf i ot4ry u Vic:; a'i= -, .rmt a�uq;o: otary,, u ►c' _ „
r ! g,
t
.Rcvisedid`ILI6/2016