HomeMy WebLinkAboutChange of Subcontractor , electricCOUNTY
1' L 4 R I D rl -'
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
,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
far job Statues greaser than $2,500 (57,500 if A. C' Change -out). A recorded copy trust 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: U a 1
Permit Number: 01
Site Address: �' Y
G & G Electric, INC
Original GC, subcontractor or.-
owner/builder— - state License C13002278 SLC License 13727 y
ry
_ 3r-��g
New GC, subcontractor =state License..�SLC License
Reason for Cancellation �O p Y V D ( ,
The undersigned does hereby agree to indenmify and hold harmless St Lucie county,its Officers. 89ents and
costs, fees or damages arising from uny and all claims of action For any reason, which may arise as a result thisemployees
slchange o from ail
contractor/subcontractor or cancellation of permit. A permit cannot be csncgied if work has been performed,
5fCNATURt O 'OWNER (or
PAINT NAME ownerlb lerl —~J~ C[INT
_
51CNATURE GENE —
ILt[ mR (or new C.C. as applicable)
_ � _ -' ,,.#
* PRINT NWE .i 1tYI .? h-�kel—
WHIe of Florida, Couagr of St- Lucie County
The foltowin6 strum"" c acknuu•ledged he&arc nx du,
—. • hy—
W ` �• — ti�,�who is Pclxonali - f rno+.n t� n1c
or �pwdu as ID.
_�a
signature of Notary dare
a i'YlPoblrc 51abl a Flr,da
Hannah E MStxe
�Y Commmaroo HH 0 ?099
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State Of Florida. County afSt. Lucie County
Thc opowlrlg'n. �i 'Ilk' c ac wiedged before me this
!fay of'. Z1 . by
l T l who is �.
prrsnnalf) known to
e r wile hag prod ed as ID.
SlQtuture of Notary Date
Notary Public State of FlorWe
Hannah E Moore
r My Commission HH 01')Ogg
�i�p Expires 07101/2024