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HomeMy WebLinkAboutChange of Contractor, electricDocuSign Envelope ID: 7C6C9595-C63F-4DF5-8380-10A73B4E876F PLANNING & DEVEL®PMEN7 SERVICES BUILDING & ZONING DIWSION 2300 VIRGINIA AVE FORT PIERCE, AFL 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 till out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub - Contractor. 511141— CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done. Canceilation 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. Gate: Permit Number: 2104-0703 Site Address: 5711 Hickory Drive, Fort Pierce FL FTL Electric Original GC, subcontractor or owner/builder Stony Electrical Contractor LLC New GC, subcontractor Reason for Cancellation Due to illness State License EC13002850 SLC License 23063 State License EC13006942 LC 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 contractor/st c,%�%.. cancellation of permit. A permit cannot be cancelled if work has been performed. e� SIGNATURE O iEt'/builder) SIGNATURE GENER L CONTRACTOR (or new �licable) PRINT' NAME --� f ile) � PRITT1AME- 1CRIAP-I)�I 11 Cll.�SC6 State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County The following; iustnunent was acknowledged before the this Tae following i strument was ackn vI dged efore mII� his ' �dayof 20 y Pfziq I . j©5&p� `7"hioLl5oeaf me or who is RM ����,o� a 29, 20 'pF`•' i 2p ••, T° Bonded ���� ^�••� ��� r�rp�' �IlII Ottli�i` \0