HomeMy WebLinkAboutchange of sub- contractor formsPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
COUNTY 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 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.
'y 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:
11/18/21 Permit Number: 2004-0619
Site Address: 1578 Digiorgio Rd., Fort Pierce, FL
State License SLC License
Original GC, subcontractor or owner/builder
Z& /UO V_e_1 U _T4C_ State License z!�_e 130Q16,Z?SLC License 22j- q 2-
New GC, subcontractor
Reason for Cancellation Original no longer in Business
The undersigned does hereby agree to indemnify and hold harmlesfany
ty, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action forich may aras a r of this change of
co for/suborn for or cancellation of permit_ A permit cannif Ivor bee armed.
SIGN OF O (or owner/builder) SIGONTRACTOR (or new GCLS apphcah )PRINT NAME ' PR
state of F da, County of Sl. ie ounty� State of Florida, County of St Lucie County
e fqllowmg instnmtent was aclnowledged before me this The following trurnent ores acl�owiedged ore me this
day of—� U�616%0 2� by_��j�[Ld 7, �', `aaY of g,��zo�
w4a is pemmally > w"7i to me �� V �, C+ ado is personally i¢town to
has pr
_
_ _ as ID.
11/1a/21
Signature of
Date
.L
s9
JULIE NIKLES
Notary Public
r`^1
State of Ohio
Re vi se
• o
My Comm. Expires
May 17, 2025
MOOT roducod as ID.
11/1821
Signature of Notary Dats
JULIE NIKLES
Notary Public
State of Ohio
My Comm. Expires
May 17, 2025
PERMIT # ISSUE DATE
i .
COUNTY
F L O R I D A
RG Novello, Inc.
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
(Company NamefIndividual Name)
the Electrical
(Type of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for Electrical Design Consultants, LLC
(Primary Contractor)
For the project located at 1578 Digiorgio rd., Fort Pierce 2428-133-0001-000-6
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
CTOR SIGNATURE (Qualifier)
AOffNAAa
C6UNTY CE TIItl ATION NUMBER
State of only of
The foregoing instrument was signed before m'e this day of
Q ,zti�,by G
who is personally known _or has produced a
COUNTY CERTIFICATION NUMBER
State of Fla rids, County of bV V u lo—
�
J
The foregoing instrument was signed before me this L day of
�JW'ttdNW / zoZV, �4mWV, A�A
who is personally known —or has produced ■
as identification. as 'dentification.
V
STAMP STAMP
of No ry Pablic nature of tary Public
Print Name of Notary Public F nt Name of Notary Public
n
JULIE NIKLES
_ Notary Public �y sv JULIE NIKLES
stotc of Otilu
Notar
tPublic
Revised 11/l6Rot6 a ^; ,f.. ... '1 My Comm. Expires } mow:...: Stae of
~oti o� May 17, 2025 �o�'' s v r, My Comm. Ohio
Mayo May 17, 2025