HomeMy WebLinkAboutCHANGE OF SUBCONTRACTOR, ELEC, 11.28.20PLANNING & 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
co crag any work. There is a $50.00 fee for the Change of Contractor.
m
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
t of the
permit.
Date: 7 c� , ,, p
Date: ! ! !� 2,0 Permit Number: � V 1 - 0
Site Address: ,
IY P( State License_f L EG 3 SC LlcenseZ
Originalr act o GC, subco r-atowner/�ulld-err
I/
j [% �f Liz (�](Z(11 ! i5t-License f�li 13 9 qce se
SLC Licen e
Ne
w GC, subcontractor ' jf
Reason for Cancellation V(/✓�-ems t�L-���o1�0� 64/ , Vr W i(y/y� f)-
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, a mployees from all /
costs, fees or damages arising from any and all claims of action for any reason, which may ari as a result of is change of
contractorr/s� tra cancellation of permit. A permit cannot b elled if work h r d.
,fIMATTJREOF OWNER (or
owzcr/builder) SIGNAT EGENERAL OMRACTOR(or rim GC, asjra��pp�liw�b�l/]dI)
PRINT NAME !'�^f (/�i."*u ,�11�,I PRINT NAME ✓,
State of Florida, County ofs446 aie4swity )`,I F 16,a A State of Flonda, County of &-. • ••
Th ,t(�lowing instrument was acknowledged bl4,fore me this .���trl�,lowing i mart was acknowledged re a this
�J��"�da of't "� , 20� by 1fti ri of� 20 Yy by �°aa
FYI � � who is personally known to me who is personally known to
or oduced,E'lDtas In. or, o has produced as ID.
��1/2�TJ _ _ G 1 a-�� LJ
Signafur f\ofary Date,5&-.44-`.`7- 8C -0-4 Srgnat reor Notaq• Date
Revised oa/is/ts h' •�fi,�: MY COMMISSION #GG192808 JULIAROMEO
`•'1 EXPIRES: March 6, 2022 'A MY COMMISSION# 00102809
•• ,pt , S•� Bonded Thru Norery Public UndniwdEen ... EXPIRES: March 8, 2022
. `' '�•• Bonded Thru Notary PuNlcUnderwrl u►
PERMIT t/ i (�)`00 9 w Q 'P ISSUE DATE
_ PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
i r- N me/If�dfvt�du%/>Name) I l t l Chl� e have agree of be
the Sub-contractorfor n(� J
(Type of Trade) N
(Primary Contractor) p(, For the project located at ::L3Com, 1 Ma r� f-
(Project Street Address or Pro 3 /t C pefry 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.
C0�4 GNpfURg�oa -
(Q Haer)
//L:T 0�? 2—
COUNTY C'E-- --CATION NI 01D.R1
Stateof Flodda,CauntyoF �fI /�YJGI iQ r�jj�`�_
The foregoing instrument was signed before me this /!! aay of
Nuy�M ,20 by Napo,,,•.
whn Is Pen___ on�Hy t�-t: ar bsa prodaeed a _
ar�FnNRcadon. �
Signsture of—tary PabHen STAMP
Print Name or Notary Public
. - "." JULIAROMEO
,a". =:
MY COMMISSION 1{ GG 192609
y, a EXPIRES: Match 6, 2022
�ro?in.�9ontled Thru Nofsry PublkVsderwAlrn
Revised tIn 016 „•
RhCTOR SIG/ Z'
{Qnalinor)
PRIN.i[f
f'G r ICATION ATA � Za z/
COun Y CERFFIltlHt7l $I[
State of Florida, County of
•� 55
The foregoing iostromeut was signed before mt thr,}, da of
who's pemsift ykaowa ar bas produced < 1 `
as II(deeentittificatioo/n.
Sig --- uTrc ofnat»rYP He STAMP
Print Na cofNot PabBe � I
K4iei:Cr" AUDREY B. HUMPHREY
i 5......xti•:
MY COMMISSION;<GG 300817
;-;a•;d,� EXPIRES: March 6, 2023
' - 5aerkdThmNatary PublicUndc �xrders _�