HomeMy WebLinkAboutBuilding permit application I
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Planning&Development Services
Building&Code Regulations Division
Q 2300 Virginia Ave.
o Fort Pierce,FL 34982
(772)462-1553 Fax 462-1578
CEMNGE OF(CONTRACTOR
Or Subcontractor or cCanceHatioan of Permit
Change of Contractor is to be completed 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,
signature, and transfer fee. 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. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
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Date: 10/13/2020 Fermat Number: 2008-0277
Site Address: 9500 POINCIANA CT.,FORT PIERCE,FL 34951
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State License SLC License
Original General Contractor(or Subcontractor)
ACCURATE ELECTRICAL CONTRACTING,INC State License EC0003072 SLC License 19629 4
New General Contractor(or Subcontractor)
Reason for Change
II
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 or cancellation of
permit. A permit cannot be cancelled N work has been perforline j
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SIGNATURE OF OWNER (or owner/builder) SIG TUBE OF QW�JGENERAL CONTRACTOR
PRINT NAME PRINT NAME
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State of Florida,County of St.Lucie County State ofFlorida,County of St.Lucie County
The following instrument was acknowledged before me this The following rostrum was acknowledged befo a me this
day of—______,20_,by day of;�O—�bY�4'I/
who is personally know to me who is personally know to me j
or who has produced as ID. ory as produced s ID.
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/ '—/� 21
Signature of Notary Date Signature of Notary l Date
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*Only signature required for change of subcontractor `��O�EL\5 IOAIRG/u0���o
Revised 07/21/14
*- O 6 A
Z;.oGG137107
jay'.;1p°�ded ttiN ��°�'-
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PERMlT# L� A ISSUE DATE fG� / q / '7-D L 0
]PLANNING & DEVELOPMENT SERVICES
Building & Coyle Compliance Division
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BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT I
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ACCURATE ELECTRICAL CONTRACTING, INC have agreed to be
(Company Name/Individual Name)
the ELECTRIC Sub-contractor for D.V.T. HURRICANE SHUTTERS, INC.
(Type of Trade) (Primary Contractor)
9500 POINCIANA CT. FORT PIERCE, FL 34951
For the project located at �
(Project Street Address or Property Tax ID#)
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It is understood that, if there"is any change of status regarding our participation with the above mentioned
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project,the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Subcontractor notice.
CONTRACT R SIGNATURE(Qualifier) SUB-CONTRA OR SIGNATURE(Qualifier)
1 Y t GYY'1 c.to
PRINT NAME PRINT NAME
COUNTY CERTIFICATION NUMBER CO�YCCERTIFICATION WMI IBER
State of Florida,County of S�- �+ — State of Florida,County of
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The foregoing instrument was signed
before me this L)day of �j The foregoi g instrument was signed
-before me this LZ day of
,20� Y`!�'+/�
who is personally known`or has produced a who is personally known V or has produced a {{I{l
as identification. as id e 'cation' �\ �Rc .``••••••:,�/O /"'
Vivian&MAluerg� 6`�—� �� `= :•�w°� SII�
S gnature of Notary Public G�2Qj Signature of Notary Public = ®v
v' c. � �� -�'�'•....WS EXPIRES:April 3 29 202 Dorise C.�irgilio =y�; ,37,
Yl a jn �IlflQ'B flllif
Print Name of Notary Public �1�f7 iOtary Print Name,of Notary Public c Ura.••F•��
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Revised 11/16/2016
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