HomeMy WebLinkAboutChange of Contractor PLANNING& DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
s 2300 VIRGINIA AVE
D
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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.
12—le 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: 4/16/2020 Permit Number: 1910-0875a
Site Address: 12`YALENCIA LN
LAWS ELECTRIC,INC. State License SLC License 20,98
Original GC,subcontractor or owner/builder
FLORIDA STATE ELECTRIC,INC. State License SLC License 27267
New GC,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of t ' e of
contractor/subcontractor or cancellation of permit.A permit cannot be ca a 'f work s bee erfo
SIGNATURE OF OWNER(or owner/builder) SIGNATURtGENERAL CONTRACTOR(or new G ,as pplicable)
PRINT NAME MATTHEW LYLE WYNNE PRINT NAME ALAN WALTON
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The fo.11p wing inst meet was acknowledged before me this
"day of IZ I L ,ZOQ by MAT THEW 1111111E )-Say of P L 20 c by L- Wq TON
who is personally known to me who is personally known to
or who has prod ed as ID. or who ha produced as ID.
c+a 4/16/2020 fC.,4}/96/2U2
Signatur6i Notary Date Signature of Utary Date
Revised 04/15/16
PERMIT# 1910-0675 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
•
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
I
FLORIDA STATE ELECTRIC, INC. have agreed to be
(Company Name/Individual Name)
the ELECTRIC Sub-contractor for WYNNE BUILDING CORP.
(Type of Trade) (Primary Contractor)
For the project located at 12 VALENCIA LN
(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
filing of a Change of Sub-contractor notice.
CONTRACTOR SIGNATU (Qualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)
MATTHEW LYLE WYNNE ALAN WALTON
PRINT NAME PRINT NAME
08898 27267
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of ST. LUCIE // �IILL State of Florida,County of ST. LUCIE
The foregoing instrument was signed before me this/(� a y of The foregoing instrument was signed before me this L day of
&JUL zo L 200�b
MATTHEW LYLE WYNNE ALAN WALTON
P
who is personally known ✓0r has produced a who is personally known✓r has produced a
as identification. as identification.
�a�" AA STAMP STAMP
Signature of Notarycblic Signature of Notary f5blic
�/ Jt}n1�J S+�!n� x o r2 o7►-f `/
o 12.0�1 1�
Print Name of Notary Public Print Name of Notary Public
DOROTHYANN BASKIN I D RGTHYANN BASKIN
MY COMMISSION#GG 030145 j+ MY COMMISSION#GG 030145
; , P EXPIRES:October 2,2020 EXPIRES:October 2,2020
Bonded Thru Notary PubHo Underwriters BBf18b8 Thru NolYry Pubik Underwriters
Rev