HomeMy WebLinkAboutChange of Subcontractor 2104-0311PLANNING & DEVELOPMENT 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 TBE 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.
CANCELLATION OF PERIVH"I' — 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: 01/14/2022 Permit Number: 2104-0311
Site Address: 601 39TH ST, FORT PIERCE, FL 34947
GOLDSTAR ELECTRIC INC
Original GC, subcontractor or ownerlbuilder
State License EC13002082 SLC License 23575
STEVE'S ELECTRIC OF SOUTH FLORIDA INC State License EC13006560 SLC License 31855
New GC, subcontractor
Reason for Cancellation Original electrical subcontractor unavailable to perform work
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/subcontractor or cancellation of permit. A permit cannot be cancelled ' ork has been performed
SIGNATURE OF OWNER (or owner/builder) SIG14YFURE G IVFRAL CONTRACTOR (or new GC, as applicable)
PRINT NAME Walls'n Roeam AV Holding InveoftnW LLC NAME Marclo Silva, Bela Vista Contractors, Inc.
State ofFlmW County of St- I.ncie County
The following insliumeint was acknowledged before me this
14th d.yof January 20 22 walsin Rornero
who is penandlly known to me
or
_as ID_
01/14/2022
Signature of NX6 Y Date
liUD" LOPES
:J *7.20X
State of Florida, Crnnty of St Iaxie Cavoty
The following insert was admowladged before me this
un day of 4-my 2022 by Mudo�M-
wha is personally known to
me or who has Epoduced as ID_
01/14/2022
Signature of ry Date
.� MUDSON LOPES
EVAM ri: �'�B101�I f Hf t8tl�
J*7,M
W&WI.