HomeMy WebLinkAboutCHG OF SUBCONTRACTOR, ELECTRICCOUNTY
F L 0 R I D rl A101
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-I578
P EASE G EC'f p E T� F yyi� ;
_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 fled In the new contractor's name
for job values greater than $2,500 (S7,500 if AC 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 —
The new subcontractor must fill out a Subcontractors Agr ement Form. There s aompleted changes are to be`S5000 fee forby theChange off Sub.
eral tor.
Contractor, o
—CANCELLATION OF PERM"' — "I he cancellation of a pennit 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: LQ I 01
— - Permit Number:
Site Address:
G & G Electric, INC ---------
Origin a] GC, subcontractor or owner/builder State License EC13002278 Sl.0 License 13727
` State I iccnse.I��Sif• License g
Netiv GC, subcontractor
Reason for Cancellation I Y
The undersigned dots hereby agree to indemnify and hold harmless St F.ucie County,its officers
Costs, fee.; or damages arising front any and all c' ,duns of action for any reason, which may arise as a result of this change of
,agents and employees from all
contractor/subcontractor or cancellation ofpermit. A permit cannot be caece ed if work has been performed.
51CNATUttL• OY UW,VER (or owner/builder) 4E, _..
SIGNATURE GEOVTRALTp[t Jo�new GC. as applicab'c1
PRINT NAME {
5� — PRFNT N.NME- F
Statt of Florida. County of St Lucie Couaty � ---
The following irlatrlrmcRrl writ acknoulcdged hercire me tln, State of Flatida. County of tit. Lucie County
_ �+ y� f°l�"'rtr8 t t c ac gnwtedged betore me this
dayot'-. SL..20� ry OF
hY-- _ day o1' U m 2) 1 by— .
'-Y-owho ra persoiraitg known to are1— — -
r o has to ed— who i c
p as fD. per<nnally known u.
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ti ^ �tc °r Who hasp cd ... A n tD.
Dat
staltsture of Notary r
Slanalureof Votary Date
a
je% 7�uWrc Slate of Ftprrtla ;�
pear � Notary Public State of Fp1da
Hannah E Moore Hannah E Moore
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'+aw Co017099Expires 07gilr2024 s My COMMISs+on HH 017099
?oi Expires 07101/2024