HomeMy WebLinkAboutChange of ContractorA2P0045B L70C C (Building)
t
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 REGEI L',Z
(772)462-1553
FAX 462-1578
AIR 6,17
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.
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.
6169N11 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:
Site Address: 6189 N US HWY 1 Fort Pierce FL 34946
Permit Number: SLC 14090281
Olin Wayne Companies Inc State License CGC1522173 SLC License
Original GC, subcontractor or owner/builder
Glotel Inc
New GC, subcontractor
Reason for Cancellation Contractor No Longer Assigned to Job
The undersigned
costs, fees or dar
License CGC1522761 SLC License
�direby agree to Indic and hold harmless St Lucie County, its officers, agents and employees from all
arising fro any and all claims of action for any reason, which may arise as a result of this change of
)r or cellation of permit. A permit cannot be cancelled if work has been performed.
State of Florida, County of St. Lucie County
The following instrument was acknowledged before /mee this
day of IMrA . 20�, by��i.J�1
Aelll� who is personally known to me
or who h s as ID.
9
n, 3l 2-)l 11
Signatu a of Notary Date
Revised 04/15/16 EKE
tate of Florida
GG 027530
Expires
SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
101WN
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of _ 20_, by
who is personally known to
me or who has produced as ID.
Signature of Notary Date
A2P0045B L700-- �C (Electrical)
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CO
PLF,4SE 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
comme
ncing any work. There is a $50.00 fee for the Change of Contractor.
XCHANGE 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.
6799NO 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:
Site Address: 6189 N US HWY 1 Fort Pierce FL 34946
Essential Electrical Solutions Inc
Original GC, subcontractoy or ownerlbuilder
New GC, subcontractor
Reason for Cancellation Contractor No Longer Assigned to Job
Permit Number: SLC 14090281-01
License EC13005534 SLC License
fZ-,00��Lf;a
License SLC License
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or da es arising from anyand all claims of action for any reason, which may arise as a result of this change of
contractor/s c tractor or c el�ion of permit. A permit cannot�ecaleel if rk as been performed.
s'
/W
SIGN& -(or owner/builder) SIGNA GENERAL CO CTOR (or new GC, as applicable)
PRIDii NAME,Tae V&& PRINTNAME���
of Florida, County of St. Lucie County
The following instrument /w,as acknowledged before me thi ,a
day of/APC/I .20� by 4W
400`� who is personally known to me
or who has producMa as ID.
Signature of Notary Date
Revised 04/15/16ZE
c stateofFloridasion GG 027530
1912018
State of Florida, County of St. Lucie County
TfidAilewing mstru nt was ackn�401edged fore i '.
day of �l �' 20'/ Ilby 11
who ' personally kn to
me who has produced 1�
0 Di
Sign a otary Date
DENISE RODRIGUEZ
MY COMMISSION # GG 084538
{- EXPIRES. March 16, 2021
BondedThruNotary Public Undervrtiters