HomeMy WebLinkAboutChange of Contractor, ElectricDocuSign Envelope ID: 9711BD48-1203-4570-83E5-CABE3CF4BOAB
PLANNING & DEVEL®PMEN7 SERVICES
BUILDING & ZONING DIVISION
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.
1530Pi , CANCELLATION OF PERMIT — The 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: Permit Number: 2101-0385
Site Address: 1530 Pineburke Lane, PSL
FTL Electric
Original GC, subcontractor or owner/builder
Stony Electrical Contractor LLC
New GC, subcontractor
Reason for Cancellation Due to illness
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 from any and all claims of action for any reason, which may arise as a result of this change of
contactor/raalafyAr cancellation of permit. A permit ca of be cancelled if work has been performed.
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SIGNATURE er/buitder) SIGNATURE GENER LCONTRACTOR (or new pGcsble)
PRINT NAME Gffrn& aD�►r PRINT NAM86 6044t4 t% o�/Q % ���CSC&7C
State of Florida, County of St. Lucie County
The followmg instrument was acknowledged before me this
day of-� � 0 by E
to me
Fain jr& °°Q�\'�
�' 8LI 119 tit Oaa\a,
State of Florida, County of St. Lucie County
The following in went was aek[_oowledtt �l befogt}�e his.
��dayof VAl1 D-12,by�C7Loi? 'JC�pp! v6p ws"