HomeMy WebLinkAboutchange of contractorPLANNING & 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.
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: 9/29/2020 Permit Number: 2M-0196
Site Address:
FLORIDA STATE ELECTRIC
Original GC, subcontractor or ownerlbuilder
ARC MASTER ELECTRICIAN
New GC, subcontractor
Reason for Cancellation
License SLC License 27267
License SLC License 31751
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 this change of
contractor/subcontractor Ilation of permit. A permit cannot be cancelled if work has been erformed.
SIGNATURE OF O or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as app&able)
PRINT NAME MATTHEW LYLE WYNNE PRINT NAME UATTHEWLYLE'VV'YNNE
State of Florida, County of St. Lucie County State of Florida, County of St Lucie County
The (following iinsstrument was acknowledged before me this
o day of SOnDod&20 90 by w.-- -tvxxe
X who is personally known m me
The following i moment was aclmowledged before me this
_,A'LTday of-&2by M0
X
personally known to
(''� or who has iodated /� as ID.nme or who ha/s iodated as ID.
I LO-Iglw" CLjK — 9/29/2020 t(SI,Q•yflf�y (,�y�., +,e,E.. Smre 20
Sip.Q. of Notary Date Signa of Notary Date
Y�17•'•4 DOROTHYANN BASKIN
Revised 09/15/16 3F*@ OOROTHYANN BASKIN ;:;'f''•t MY COMMISSION#GG 030145
MY COMMISSION#GG 030145 ,e EXPIRES: October 2, 2020
j EXPIRES: October 2, 2020'�<„y;,o;:+'
is
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BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982
772-462-1553
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
RE: 0�naL�U.
Permit #
Credit Card Users: 1,50loSurcharge added per transaction.
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
VISA MASTERCARD
Credit Card Numb r vl \ G "l \ � S�k hA �) Ol S 0
Expiration Date % N �t' 3 Zip Code
3 digit security code 1943
Amount $ SO— + 1.5% surcharge
Business Name: w �,Mr P- C,M7 ,
Authorized Signature:
Print Name:
Phone: (1��) c6rLSS - 1-'j15 k-23
Fax:
Comments:
c2Ce..�k �v
SLCPDSD Revised 4/01/2010 EN