HomeMy WebLinkAboutCHG OF SUBCONTRACTOR, ELECCOUNTY �.-
F L 0 R I d n.
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
P EAS : LCCC O OF WIN
_CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owne
mr,
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 (S7,500 if A..'(' 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: (o i 7 r
�— - Permit Number: rt�
Site Address:— - _
G & G Electric, INC — — — "— —
Uriginal GC, subcontractor ar awner/builder — -State License_EC13at}2278— SI.0 I-icense 13727
+ � State License 1�7New GC, subcontractor
SLC License 31749
Reason for Cancellation
CC' 1r , —
The undersigned does hereby agree to indensnify and hold harmless Si Lucie County, its office
costs, fees of damages arising from any and all claims of action s, agents and for any reason, µhi h may arise as a result employees
of
contractor/suhcantracfor or cancellation ofpertnit. A permit cannot be canee ed if work has been performed.
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S[GNATURti OF OWNER (or
PREN; NAME ouncrPouilder) _
La 4 SIGNAi"UR�GEN8CO� RACTOR (ar new GC, as appiicrth2el
._B. _M4 _ PRINTN4ME
co Flotidn, County of St. Lucie Cnr.nly
The7fotlpwtng instrument wac acknowledged ixrore me thr,
dayof �0_ by
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wlt,�
peiaonat13 known to n1e
Mvho has prod ed as ID.
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Signafnre of Notary Date
N�4 f nnah E ie Slate or FlQnda
Hannah E Moore
MY Commys,On HH 017099
0' ExPirea Wi0112o24
State of Florida C'ouptyof 51. Lucie%unty
The following in`trum-it was acknowledged before me tlMs
claYhnty� . _. 21)� by_-
�' try n IS Pmnnatiy knoNn u.
m • or who has P turd as 1e1.
",&1� a
Slanature of .Notary Date
�var Notary Pub1;C State of Ftpoda
Hannah E Moore
• My COmmIssron HH 0170W
n Expires 07101re024
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