HomeMy WebLinkAboutChange of SubContractor, ElectricPLA NING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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 PERNUT — 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: L1 1 1 U
Site Address: .59 ID-1 �) ` Y, cY
G & G Electric, INC
Original GC, subcontractor or owner/builder
Permit Number: a 0 0 �- u-�> 3 S
State License EC13002278 SLC License 13727
(—"\ OL �f C_- Y-r C State License 9_ C.L)C:7(2_393SLC License
New GC, subcontractor
Reason for Cancellation N v
� Noy Kin q Uvi-rvn
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 has been performed.
SIGNATURE O OWNER (or `j�, ownee(rlbuilder) SIGNATURE GE AL CONTRACTOR (or new GC, as applicable)
I �
PRINT NAME • � . ! lIn M S PRINT NAME ot✓t�( xninii7 C)
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of�� r20011 , by
lit t r t) wh i is personally known to me
�or ho has produc d as iD.
�0 ou 1� 1�11 a 1
Signature of Notary Date
ar=r °tip Notary Public State of FLonda
Re is ;8 i 26Hannah E Moore
< My Commission HH 017099
Expires 07/01/2024
State of Florida, County of St. Lucie County
Th following instrument as ackijpwledged before me this
day of� , 200 by
U t► nt a D D who is personalty known to
me pr who has nroduced as 1D.
Signature of Notary Date
Notary Public Slate W Ronda
Hannah E Moore
My Comm,"1111 HF1017099
Yd Expires 07/01r2024
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