HomeMy WebLinkAboutChange of subcontractor, electricWE
COUNTY
I L U R E D it
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
for job values greaser than $2,500 ($7,5pQ if AaG Change -out}. A recorded copy rrtthe 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 e Chan.
Subcontractor Agreement Form. There is a $5000 fee for the a of
Contractor. g Sub -
Contractor. OF PERM11- - The cancellation of a permrt is acceptable only i f 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: _ I,t ioC `
— -- Permit Number: �
Site Address:5_5
IS & IS Electric, INC -- — T — — — —
Original G usC, bcontraclor or awner/b ldu, rc State License EC13002278
_St.0 License 13727
��r3L-1'�—State Liccnse I� New GC, subcontractor 5 _ LC Liccnse
Reason for Cancellation i Mr
The undersigned does hereby agree to indemnify and hold harms° i(!11'1!' l,louny, its off -peers. agents and e
costs, fees or damages arising front any and all claims of action for ny reason, wh tch may arise as a result of this from
of all
contractor.+subcontractor or cancellation ofpermit. A permit cannot be coneged if work has been performed.
3
SEGNA-170RRRE OF UwNtitt (or owtserbuildcr}
SI[iIQArLlRE GEN! {'O,yrRg
PRINT T for new C;C, as applicable)
PRINT NAME��� i�
PRINTN.�ME f State �—
of Florida, County of Sr. Lucie Couary•
The f'ollounng instrumcal wits acknowledged hnfore me tht, State of Honda. CountyofSt. t.trcle County
lThe following in. s c acledged before me this
_dayaf Skr4 1p�.by __. �daynf
�.., 213 by
A16a�_Swho is personall} Iota-n in nic Eh l 'vi#ir l �`
o has produced S. _ who is personally kaow,� ro
as ID. II ee i �e r whL1 ha> prod _
ID
11
0sig]t,r
at Notary Date " -' `-i a
Signature ar,Notary Date
s�p•�u 4 %'"rjfuola: State or Ftorida �Y_OFF_L_--
.r �4._ Notary Public state of FRonda . Hannah E More Hannah E Moore
MY Comm t0 1099 . MY Commission HH 0170N
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