HomeMy WebLinkAboutChange of ContractorLJ
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
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.
B-ma 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: N-10/2929
Site Address: 8 dAsMlN€ W
Permit Number: 1Q-19087
LAWS €MPTRIE, INC:- State License SLC License 2Q95
Original GC, subcontractor or owneribuilder
€WRJPA, STAT€ €MC_ TRIG, INP. State License SLC License 27207
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 ge of
contractor/subcontractor or c tion of permit. A permit cannot be n fled7ifwks een erfo d.
i
SIGNATURE OF OWNER (or owner/builder) SIG GENE CONTRACTOR (or new C, pplicable)
PRINT NAME MATThgW LYL€'YYYNNE PRINT NAMEALAN WAFT N
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of m l L , 20� byMATTH
EW LYLE YNNE
✓ who is personally known to me
r who has rMed as ID.
6"L. 4/16/2020
Signature Notary Date
Revised 04/15/16
State of Florida, County of St. Lucie County
X�ng instrument was acknowledged before me this
day of /PR / 4 20_by A, w-TON
V who is personally known to
or who h.. aaas produced Q as ID.
:X a, Ivaolc—R146/2020
Signature of obtary Date
0 •
PERMIT # 1910-0 V 87 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
:a Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
FLORIDA STATE ELECTRIC, INC.
(Company Name/Individual Name)
the ELECTRIC
(Type of Trade)
For the project located at 8 JASMINE LN
have agreed to be
Sub -contractor for WYNNE BUILDING CORP.
(Primary Contractor)
(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 SIGNATURE (Qualifier)
MATTHEW LYLE WYNNE
PRINT NAME
1::•:
COUNTY CERTIFICATION NUMBER
State of Florida, County of ST. LUCIE
The foregoing instrument was signed before me this _'day of
PRlL ao Vby MATTHEW LYLE WYNNE
who is personally known _�6r has produced a
as identification.
G, /� STAMP
Signature of Nota ublic
Print Name of Notary Public
DOROTHYANN BASKIN
MY COMMISSION # GG 030145
EXPIRES: October 2.2020
Bonded Thry Notary Publir, Underwrtilers
Revis
SUB-C9TCT( R09P
SIGNATURE (Qualifier)
ALAN WALTON
PRINT NAME
27267
COUNTY CERTIFICATION NUMBER
State of Florida, County of ST. LUCIE
The foregoing instrument was signed before me this L� day of
c. 20ao by ALAN WALTON
who is personally knowor has produced a
as identification.
ka-'t-0 'k-4 �� 16 Gam— STAMP
Signature of Notar} iblic
Print Name of Notary Public
_DOROTHYANN
BASKINMYCOMMISSION
Ei"
# GG 030145EXPIRES;
October 2, 2020Bbntlbd
T n' Nnlary public Underwriters