HomeMy WebLinkAboutChange of Contractor, electricDocuSign Envelope ID: F3260568-3B40-4445-AC15-578D93F439B5
PLANNING & DEVELOPMENT SERWCES
BUILDING & ZONING DIVffKON
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERIMT
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 Fonn. There is a $50.00 fee for the Change of Sub -
Contractor.
961
0-- 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: Permit Number: 2102-0600
Site Address: 9640 Fairwood Court, PSL
FTL Electric
Original GC, subcontractor or owner/builder
Stony Electrical Contractor LLC
New GC, subcontractor
Reason for Cancellation Due to illness
tate License Ec13002850 SLC License 23063
State License EC13006942 SLC License
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising fi-om any and all claims of action for any reason, which may arise as a result of this change of
contractor/subbgeftmaWcoiboancellation of permit. A permit cannot be cancelled if work has beem performed.
-wlwcy g Daat;w
_ �2ha0.rl Jo &ph
SIGNATURE OF Orb' 'r or Iowtier/builder) SIGNATURE GENERAL CONTRACTOR (or new GC,, as a ✓ ,
PRINT NAME A/ancy �i_ F� b PRINT NAMEd 60ePA AIf
State of Florida, County of St. Lucie County
State of Florida, County of St. Lucie County
The fallowing instrument was acknowledged before me this ii p,,�H��� The oRowing, instrument was acknowledge f e ne tl
�� day of A UAAA fp by � �/ 'J�1"�"A. _dayof�;0 by 1 CZL
----_ D,� WA-- --ai 4Cwit to me /who is persona Ily knc wn to
or who has oclueed�"1 me or who has toclueed�4ZW ���s IfS�1Rl�� 9JG140/
yip p \����pFt N �mk 4i 0�°°�<��
Si- atur f Notat a Date rt= Sig attn f Notary Date Qom: p�J �29 2p24 o,�
�oeondedN'�a j° �`�<� #piH000454
° 4 w
pU F:::I 5•��pFIayNI P�O�°.T�oBonded'Q o`, p4o�w
yFain Ineo°° o���a\��