HomeMy WebLinkAboutSubcontractor Update PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 J,,�
ti
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATAN-V?P T
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.
xxx CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be completed by the general contractor.
The new subcontractor must till out a Subcontractor Agreement Form.There is a S50.00 fee for the Change of Sub-
Contractor.
a 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: 06/14/2021 Permit Number: 2104-0566
Site Address: 11771 Appaloosa Ct,Fort Pierce,FL 34987
Ed's Electric,Inc. State License EC0001569 SLC License 10892
Original GC,subcontractor or owner/builder
Goldstar Electric,Inc. State License EC13002082 SLC License 23575
New GC, subcontractor
Reason for Cancellation Abandonment of Contract
The undersi ned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs s or ma es a i from ony and all claims of action for any reason.which may arise as a result of this change of
c actor ontra o can a ' of permit.A permit cannot be cancelled if work has been performed.
IGNATU rF OWNER(or owner/butldcr) SIGN.%TURE GENERAL CONTRACTOR(or new(C,as applicable)
PRINT NAME Rodney Hall PRINT NAME John Cavnar
Slate of Florida.County of St Lucie County State of Ronda.County of St Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
/ day of U K ¢ -)0 L I b,, �D] l Y n day of J v ¢ 201 L.byr ��TT
G L who is personally known to me C(-AJ V1Q,{ wiw is personally known to
o produced FL, >L ,as ID. me or who has produeW as ID
t� 06/lf/2021 ��Jaf , C-/14/2021
Signature of Notary DateSignature of Notary Date
VIVIAN A.JAIME
Revised 04/15/16 MY COMMISSION*FF974898
� EXPIRES 03/24/2024ry tio R rroury p Sate of FlorlCa
f appy* National Nota Assodan oriAa Paola BalJttstl Garay
w Carrr,nom MH 0636E3
pia Eitpttua 1111SQ 24
f
PERMIT# 12104-0566 ISSUE DATE 06/11/2021
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
W���M'
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
Goldstar Electric, Inc have agreed to be
(Company Name/Individual Name)
the Electrical Sub-contractor for Rodney Hall Concrete Construction, Inc.
(Type of Trade) (Primary Contractor)
For the project located at 11771 Appaloosa Ct, Fort Pierce, FL 34987
(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.
CONTRA ( SIGNATL E(Qualifier) SUB-CONTRA TOR SIGNATURE(Qualifier)
John Caibbo John Cavnar
PRINT NAME PRINT NAME
27478 23575
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
state or Florid. County of s T L()C/ ,/4 Sate of Florida,County of LuCi(,,e
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me thisA day of
^jy h e— .202-!by .7 u!-r�y c%<-a i �3 8 C� • j y�lQ, io .b. � ,h r, C'rx t n(7
who is perso Ily known_or has produced a FL who is personally known-S) or has produced a
as ide of ation.,/ � ss identification.
' /V� W✓I STAMP
Signature of Notary'Public Itunture of Notary Public
V I V Al Af Pao(a Gantist(a L!arca&
Print Name of.Notary Public Print Name of Notary Public foil
VI A.]AIMS q
MY COMMISSION#FF974898 �' r
Revised I I ffO%m 0%-0-4 0=1 R A A M EXPIRES 03/24/2024
national notary todanoa HOM3