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HomeMy WebLinkAboutChange of Contractor 6G 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 $50.00 fee for the Change of Sub- Contractor. CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done. Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for cancellation of the permit. Date: 8/5/20 Permit Number: 0 —60 Site Address: JO? PEAYS ELECTRIC State License ER120455 SLC License Original GC,subcontractor or owner/builder GOLDSTAR ELECT INC State License EC13002082 SLC License New GC, subcontractor Reason for Cancellation PEAYS ELECTRIC is no longer on these jobs. The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of contractor/s ontractor ancellation of permit.A permit ca nn flt ekance'Ded if work has been performed. SIGNATUREWOWslMurownerf ilder) SIGNATU$EGENERAL CONTRACTOR(or new GC,as applicable) PRI.NT 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 ofAugust 20 20 by 5 day of August 20 2�by Brian W. Davidson who is personally knownto me John Cavnar who is Dersonaliv known to or who�hasrodwe was 19. Signature of.Notary Date Signature of Notary Date Revised- ppIiWNO ,�� DIVA 935643 ;_?•"'?�•: DINAPARRIND diQ °': MY COMMISSIONtt 2024 MY COMMISSION#GG 9351i43 S February VIRE ual Unden+dters ••'` TM Diary is EXPIRES;FBbNary27,2024 %;r�;;;qe� 6ondad N 6ondad ih u Nola ry public UndenMiters PERMIT# O�Q � ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division o -- — — BUILDING PERMIT SUB-CONTRACTOR AGREEMENT Goldstar Electric Inc have agreed to be (Company Name/Individual Name) the Electrical Sub-contractor for D.R.Horton Inc (Type of Trade) imary Contractor) For the project located at (Project Street Address or Prope 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. © /J CONTRACTOR SIGNATURE(Qualifier) SUB-GONTRAC`KQWSIGNATURE(Qualifier) (ram Brian-W Davidson John Cavnar PRINT NAME PRINT NAME CRC1327068 EC13002082 COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER State of Florida,County of Brevard State of Florida,County of Brevard j The foregoing instrument was signed before me this 5 day of The foregoing instrument was signed before me this $ day of August ,2020,_ by Brian W Davidson August .20_?0,by John Cavnar who is personally known x or has produced a who is personally known X or has produced a as identification. as identification. N Signature ofNota Public N g ry Z� �a Signature of Notary Public �z Oa z d Z. aNa Z. x N LL.9 gtn ._o Dina Parrino 4z'='�;i Dina Pazrino s w e trot Name of Notary Public o Print Name of Notary Public } M.. -: i t• :u` 'v°i'•�sty I-V Revised 11/16/2016