HomeMy WebLinkAboutChange of Electrical Sub Contractor FormPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Permit
Change of Contractor is to be completed 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,
signature, and transfer fee. 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. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: 1/19/22
Permit Number: 2004-0041
Site Address: 9960 S. Ocean Drive, #1904, Jensen Beach, FL. 34957
Wayne Garber / Heritage Electric State License ER0011355
Original General Contractor (or Subcontractor)
Michael Horutz / All Power Electric Contracting LLC
New General Contractor (or Subcontractor)
Reason for Change No longer in business - COVID
SLC License 2928
License EC13006338 SLC License 30980
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 bSAwncelled if work has been performed.
SIGNATURE OF OWNER (or co ner/bander) " SIGNATURE O(_N�V GENERAL CONTRACTOR
PRINT NAME 11147'YNy✓ (fOO)LF
State of Florida, County of-6lr6na4eEeunty /M.4K c
PRINT NAME H (CL4,4-9LSb Isrmle�en/r
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p'tC�%,,tp
State of Florida, County of nty "^'• Ae1D
'the following instrument was acknowledged before me this � The following instrument was acknowledged before me this
XD day of ,e Vv 0. 20 L2 by 14'r-.r�4t.,.. e--ttYL n 2—c" day of 5Av 20 aa-` 22_ by �lC�o-�
who is personally know to me who is personally know to me^`
Nt roduc rd as In or who h p oij, ieEd` ) as In �-�••)
Signature of Notary Date Signature of Notary Date
*Only sign \'g of ryltTE�RPAYtg,ll of subcontractor iiRr°� -. r WALTER D PAYNE II
i}lta alit- ateo PlA !?° Notary Public - State of Florida
Commission k HH 32033 i.�e; Commission N HN 32033
Revised 07/21 1tv.:- My Comm. Expires Aug 25,2024
..,ark.: My Comm. Expires AugAuq 25, 2024 �'
Bonded through National Notary Assn.Bonded through National Notary Assn.