HomeMy WebLinkAboutCHANGE OF SUBCONTRACTOR, ELEC- - - - - PLANNING & DEVELOPMENT SERVICES
ICOUNTY 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 pnor 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 PERAUT — 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: _
Address.•
G & G Electric, INC
Original GC, subcontractor or owner/builder
Permit Number: - (L. 3 1-1 11
._State License EC13002278 SLC License 13727
\ -State License LC License
New GC, s contractor
t �
Reason for Cancellation
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.
S[GNA"rURE wNER (or owner/builder} SIGNATURE GENEkAL CONTRACTOR (or new GC, as applicable)
PRINT NAME a a M j — PRINT NAME_
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 ho has produc _ as ID.
Signature of Notary Date
or Notary Public State of Ftonda
Revi.5 ;8 + °Hannah E Moore
+�:aw My,-o�nm6ponHH017099
�i F rpires 07-01 r2024
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
— day of to /t. ._ . 20A, by - --
OILLn ) who is personally known to
(Rme r who has produc __ as ID.
I , A -P LL'11
Signature of Notary Date
aC
Notary Pubibc Stateof Fonda
Hannah E Moore
My CommissionHH 017099
E.pireso710tr2024