HomeMy WebLinkAboutCHNG SUBCONTRACTOR , ELECsmi
DEVELOPMENT SERVICES
BUILDING I IISION
2300 VIRGINIA
FORT PJERCE� FL 34982
(772)462-1553 FAX
2
I S 7
CHANGECT SUBCONTRACTOR
CANCELLATION OF PERMT
f EAS ° L'LCCI Q - oF' i m' F 1iV '
.�_C AE F 1'Y ACT — Change of Contractor is to be signed and notarized by the Property owner,
and the new contractor at'rccord for the current permit. A new permit application must also be completed with new
.contractor information and si aturc. A new Notice of Cotnntencerncnt must be filed in the new contractor's name
far job s`alues greater than 2,S ($7,500 if ABC Change -out), A recorded copy must a submitted
cot encing any work, T ere is $50,00 fee for the Change of Contractor. prior to
�CHANGE OF SUBCONTRACTOR
The new subcontractor must fill out a Subcontractor Agreement Form. ere s are to be completed by the genera! contractor,
Contractor. 00 fee for tits 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 n a Fee for
cancellation of the permit.
e
Date:
Permit xa Number: �
Site Address: s
0
G G Electric, INC
1
N„mm State License EC13 2278
a.. S1..0 License 13727
rl nal C. subcontractor or awner/builder — "
New QC, subcontractorn ,,.State License �� � LC [ iccnse 3/749
°"�
Reason for Cancellatioll �` 3
The undcrsi8ned does hereby agree to indelttmfy acid hold har[rtless St Lucie County, pli
costs, fees or dantages arising from any and all claims of action for any reason, which may arise as a result of this change of
its Officers. agents and emoyees From all
contractor/subconuact®r or cancellation ofpermit. A permit cannot be cancoed if work has been performed, t
SIGNATURk OF Uq"vER (or own" er�bearirler}
S[GMATURE GENE
_,..,.. _
L[� ViRAC 1 t7R (€or new GC as applicable)
PRINT NAME . �
PR [NT N %M E
Staac of Fonda, County of 51. Lucre (-panty a
The toll"'nb tnctrvntcnt was acknowledged before nx this Stare of Florida. County of of Lucre County l
NThe foliowtn m s x
day ot; act b t as aclt )wledW before me this
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s cvho is persrnralfy known tonic
r who has produ ed `I , -....9 who r., personalty knowi, tag
me rw in ah as p oced as ID.
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St;nature or Notary Date � _. : ....., _
signature of Notary Dark
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