HomeMy WebLinkAboutChange of SubContractor, Electric-- - - - 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 OLLOWING:
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 $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: -- Permit Number: oo
Site Address: t ( I44) `:�-t �
G & G Electric, INC State License EC13002278 13727
Original GC, subcontractor or owner/builder SLC License .
{^ �co� State License `�. (�. � �7� �-- LC License:
New GC, su ntractor — - -
Reason for Cancellation 1. _ L i
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SiGNA fURI WNER (or owtter/builder} SIGNATURE G6J—R CONTRACTOR (ore ew Gr as applicable)
PRINT NAME
PRINT NAME4i 1L�
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
7 day
f� m 20�. by _.
;who is personally known to me
or hp has produc d„ as ID.
Signature of Notary Date
NOtary Pubuc State of Ronda
t eV .; a$ 6Hannah E Moore
MY �om,rnssion MN 017099
Expires0€�01f2024
State of Florida, County of SI Lucie County
The following instrument was acknowledged before me this
dayyof i --' 20a1'1, by— -
r t ,who is personally known to
me r who has producl.,_ as ID
Signature of Notary Date
a
llotary Pudic State of Flpnds
Hannah E MooreMY Comm"*n "11017099Expires 07r01r2024