HomeMy WebLinkAboutChange of Subcontractor- Electrical Bldgs A-FPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTM SUBCONTRACTOR OR CANCELLATION OF PERMIT
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 52,500 ($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: 2 /2021 Permit Number:
Site Address: 9563 S. Ocean Drive, Jensen Beach 34957
2010-0252
Arlington Electric, Inc. State License EC13007767 SLC License 30840
Original GC, subcontractor or owneribuilder
Biyco Electric, LLC Stale License EC13001240 SLC License 31779
New GC, subcontractor
Reason ror 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 this change of
contract or/s contractor or canof permit. A permit cannot be cancefl if work f been Performed.
S1GNA rURE OF OWNER (or otvnerbudder) SIGNATURE GEN •RA . CONTRACTOR (or new GC, as applicable)
PRINT NAHF. PRINTNAME
�t
State or Florida, County ut� State of Honda, County of St Lucie County
Thefollowing insaument was acknowledged belbre me this
L� ` p`` day of YZ-2U k . by��
5 2 e! _ ,-who is personally knower to me
nr ho produced as ID.
t-►_ 27ttl2021
Signature of Notary Date
Revised 04/15/16 �;,YAL� JODI L PETERSON
Wary Public - State of Florida
• .z Commission t GG 072280
My Comm. Expires Feb 12, 2021
'�O`fl'� 9fsrdedlhroughtiafionalNat:ryAun.
f Ilowing rent was acknowled ed on_ a this
y of i by�
wha is or•rsonally known to -
who has Produced z s ID.
~ Sigtnture of
}i ► + t
'
—'BONNIE A. DIXON
FIDOda
+P; i 1
ry
Notary Public • State of
Q?
Commttslon 9GG 2,4365
t• ,Pt
My Comm. Expires Jun 9, 2022
Bonded through Nation&'. Notary Assn,
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 PERINIT
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 $2,500 (S7,500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There is a S50.00 fee for the Change of Contractor.
X CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a S50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERINUT — The cancellation of a permit is acceptable only if no work has been done_
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 2/8/2021
Permit Number: 2010.0267
Site Address: 9563 S. Ocean Drive, Jensen Beach 34957
Arlington Electric, Inc. State License EC13007767 SLC License 30840
Original GC, subcontractor or ownerlbuilder
Blyco Electric, LLC State License EC13001240 SLC License 31779
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor -sub ontractor or cancellation of permit. A permit cannot be cancelled If w)pric has been performed.
SIGNATURE OFOWNFR er) (orowner'builde _ —� SIGNATURE GFN�GRnAL CO� RaCTO/R {urnew GC, as applicable)
PP ENT NAMEI :jkev,�_-. PRINT NA1IEvl�
State of Florida, County orft ty
The rollowtng instrument was acknowledged before me thus
,!ayar QA-,� 20014 by t kVf•�
who is [erson4! known to me
or who has P3Ziduixd as lt)
218/2021
Signature of Votary hate
Peaased 04 '1j:: ;.,� �P"''•,,
JODII.PETERSON
Notary Public, State of flofida
. ;
z�i�ovft ,.•'
Commission i GG 072280
My Comm. Expires Feb 12, 2021
gan&dthMghnahWalWaryAoo.
State of Florida, County orSt Lucie County
wing m I. acknowledged before me this
� �} dro�f�/ Zr'-D�-$y
f vj. Gi� L n I '/Who.ss_aersonally known to
-m r Who has tmxtucod
Signature of o , V , L' A.1)OtON
notary Public • State of Florida
Commission N GG 214365
GF, My Comm. Expires Jun 9, 2022
Bonded through National Notary Assn.
PLANNING & DEVELOPMENT SERVICES
- - BUILDING & ZONING DIVISION
2300 VIRGENIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMIT
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 (S7,500 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 PERIMIT — 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: 218/2021
Permit Number: 2010.0271
Site Address: 9563 S. Ocean Drive, Jensen Beach 34957
Arlington Electric, Inc.
Original GC, subcontractor or owner/builder
13lyco Eleclnc. LLC
New GC, subcontractor
Reason for Cancellation
tate License EC13007767 SLC License 30840
License EC13001240 SLC License 31779
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
contracto r subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
5tGNArt!RL0I.OWNt_R(or ownerbullder) SIGNATUPEGENE I. TRACTOR (or new GC, asapplrcablel
PRINT NADIR t`. t 3 PRINT NA,NIF
OW 1A
State of Flonda, County otxrr;xurty
The following instrument was acknowledged before me this
iL day of 20_�:L, by
kA_> - who is personally known to me
or who has�nxtuced as ID
r" 202021
Signature of Notary Date
,e•�„p. JODI L PETERSON
P.evised : 4, 1-`1fi ¢1Notary Public -State of Florida
•. Commission#GG072280
+; My Comm. Expires Feb12,2021
aOp IlmdedthreughNationalNctaryAssn.
State of Fbnda, County of St. facie Count)
" In r t was,u aged before me this
Y
L 'Aho i_s0rr 0211Y known
who has produced s ID.
/ .. %7Natlonal
Signatureaf,�at NaWf Vicrida
Comm365
rho AAy Comm, 2022
Bonded througry Assn
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE -OF CONTRACTOR, SUBCON"I'RACTOR OR CANCELLATION OF PERUNIT
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 (57,500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There Is a S50.00 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: 2/812021
Permit Number. 2010.0274
Site Address: 9563 S. Ocean Drive, Jensen Beach 34957
Arlington Electric, Inc. State License EC13007767 SLC License 30840
Original GC, subcontractor or ownerfbuiider
Blyco Electric. LLC State License EC13001240 SLC License 31779
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 this change of
contractor`sub ontmctor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE:OFOWNER (or nwnevbuilder) SIGN:%TURE GE R:1L CO TR.ICTOR for n�cw GC, as applicable)
PRINT NAMErC' c +: PRINT NAUkIE
State o f Flonda. Coutny or t,,18=_.
The following instnumrit was acknowledged before me this
day of IF-L. 200�, by
V� who is personally known to me
or who has produced. as ID.
2/8/2021
Signature or Noma Date
Revised �J4/1S/10 �'� 1° ''= JODILPETERSON
Notary Public -State of Florida
Commission t GG 072280
=,hy My Comm. Expires Feb 12, 2021
amdedlhro*NatkmWNotary AsvL
State of Flanda, County of St Lucie County
Jp wingy of�, ,c a bbYgcd before me this
✓�����w�lly kn.wu,_knowu,._
nr-who has pwiluced as ID.
6 20
Signature or ti Y' ONNPEA. DIXON
Notary Public • State of Florida
Commission x GG 214365
}c d my Comm. Expires Jun 9, 2622
f Banded through National Notary Assn.
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
Mango. 0 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMIT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be sighed 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 S50.00 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: 2/8/2021 Permit Number: 2010-0277
Site Address: 9563 S. Ocean Drive, Jensen Beach 34957
Arlington Electric Inc. State License EC:13007767 SLC License 3W4O
Original GC, subcontractor or owner/builder
Blyco Electric, LLC
New GC, subcontractor
Reason for Cancellation
License EC13001240 SLC License 31779
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 anse as a result of this change of
contractor subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
51GNATURE:OFOWNER (prow alder) SIGNATURE 0ENE:RA♦wC )NTRACTOR (or new CC, as applicable)
PRINT NAME � �a PRINTFtKQQ Ile,
State of Florida, County o, . - y
The following instrument was acknowledged berbre me this
day or 21a
1, by
i who is personally known to me
or who has p uced as 16
a V812021
Signature or Notary Date
Revised 44f15,et5 ,�aiv'a JODI L PETERSON
r. Wary Public - State offiorida
Commission I GG o72280
My Comm. Expires Feb 12, 2021
MOF,`ti Bandedr,m*NatimalNo" Assn.
State of Florida, County of St. Lucie County
lowing i s ac ged before me this
\lTt.�ititay al' , ? by
who��, nally.kunstin.do
me o- who has nroduced ___ as ID r
Signature orN ry',.„64
921%,
hill A.01X0N
Notary Public • State of Florida
N,,
Commission 0 GG 214365
My Comm, Expires Jurt 9, 2022
Bonded through National Notary Assn.
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 PERMIT
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 (S7,500 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 flit 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 silted and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 2/8/2021
Permit Number: 2010-0279
Site Address: 9563 S. Ocean Drive, Jensen Beach 34957
Arlington Electric, Inc. State License EC13007767 SLC License 30840
Original GC, subcontractor or ownerlbuilder
Slyco Electric, LLC State License EC13001240 SLC License 31779
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 this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work
rk has been performed.
SIGNATURE OFON'NER(urownrr� uilder' j SIGNATUREGENERIAIL �^NfRACT/OR(ornewGC, asapplimble)
PRFMT NAh!£�b``"' -' PRIivTNAAI iUCL, t 1 .
� �,.r
_ I �
State of Florida, County oF>ti --t�i`State of Flonda. County of St, Lucie County
The following instrtunent was acknowlL•dged before the this
day of Wes. , 20,1, by S W�
_ who is personally known to me
who hm �t[t ed as ID
218/2021
S 9—Mure of eNotary Date
1?euisa 0�/15/l0' oi+R� ''''• JODI L PETERSON
Notary Public -State of Florida
' Commission / GG 072280
My Comm. Expires Feb 12, 2021
?OPF` gondcdthroL*Nat=NotayAsm
wing itu ac lodged before me this
doy of � by
—
Me— tf who ts
n mLE.who has p, Md.ed—T as ID.
Signature of Notir RIE A. DIXON
Notary Public State of Florida
f : ; ; Commission p GG 21434S
nd ky Comm, Expires Jun 9, 2022
a0rdrd through National Notary Assn.