HomeMy WebLinkAboutChange of Contractor SZ
__ 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 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: 8/5/20 — Permit Number: Z c?, —00-7 q
Site Address: �Q / �AJ I JV (/,Nct_
® PEAYS ELECTRIC State License ER120455 SLC License
Original GC,subcontractor or owner/builder
GOLDSTAR ELECT INC State License EC13002082 SLC License
New GC, subcontractor
Reason for Cancellation PEAYS ELECTRIC is no longer on these jobs.
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/s ontractor ancellation of permit.A permit cann t beicaneeellled if work has been performed.
SIGNATURE OF OWNEITur owne ilder) SIGNATU aGENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME Brian W. Davidson PRINTNAME John Cavnar
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged beforeme this The following instrument was acknowledged before me this
5 day of August 20 20 by s day of August 20 20 by
Brian W. Davidson who is personally knownto me John Cavnar who is nersonallv known to
i
or who has produce as-IiS. me or ced 1B.
Signature of:Notary Date Signature of Notary Date
Revised' D1NAPpRRINO
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ri?••"- ;•: DINAPARRINO :c? MYCOMMI 2024
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OMMISSION#GG 935643 p�PIRE pubricUndetwdters
EYPIPES:February 27,2024 %:e�FFge� 5cndadThniNotarY
bonded Thru Notary public Underwriters
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PERMIT# �JO�n, n ISSUE DATE _I Ll_ LID
PLANNING & DEVELOPMENT SERVICES
�- - Building & Code Compliance Division
0
o �
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
i
Goldstar Electric Inc have agreed to be
(Company Name/Individual Name)
the Electrical Sub-contractor for D.R.Horton Inc
(Type of Trade) Primary Contractor)
For the project located atJC� ��N 2
(Project Street Address or Property lax ID#)
i
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.
CONTRACTOR SIGNATURE(Qualifier) SUB-CONTRACT-OR S GNATURE(Qualifier)
Brian-W Davidson John Cavnar
PRINT NAME PRINT NAME
CRC1327068 EC13002082
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of_Breyard State of Florida,County of Brevard
The foregoing instrument was signed before me this 5 day of The foregoing instrument was signed before me this _$ day of,
August ,20_20,by Brian W Davidson August 20_20,by John Cavnar
who is personally known X or has produced a who is personally known X or has produceda
as identification. as identification.
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Signature of Notary Public z z Signature of Notary Public A
O aa. Oa Z.
Dina Parrino 4z z Dina Parrino 5 w z
UJ g
Print Name of Notary Public 0 d F_ Print Name of Notary Public
18
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Revised 11/16/2016