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.
21-0 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: 11/4/2020
Site Address: 25 GORDA WAY
FLORIDA STATE ELECTRIC
Original GC, subcontractor or owner/builder
ARC MASTER ELECTRIC
New GC, subcontractor
Reason for Cancellation
Permit Number: 2004-0307
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/subcontr cellation of permit. A permit cannot be cancelled if work performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME MATTHEW L'YLE WYNNE PRINT NAME MATTHEW LYLE WYNNE
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20 a0 by hV'EWLYLEYNNE
X who is personally known to me
or wh as produced as ID.
11/4/2020
nature of Notary Date
,Yo DOROTHYANNBASKIN
Revised 5/ 6 MY COMMISSION # HH 045443
d :;; EXPIRES. October 2, 2024
°P Bomled Ttxu Notary PubBc UndetlMritera
7Th following i trament was acknowledged before me this
dayo�.20.Eby nu--L--NN1
X who is personally known to
m or who ha produced as ID.
11i4i2020
Signature of Qtry Date
DOROTHYANN BASKIN
MY COMMISSION # HH 045443
EXPIRES; October2, 2024
Bonded Ttuu Notary public Underwriters