HomeMy WebLinkAboutChange of Contractor RECENED
- --_ - PLANNING&DEVELOPMENT SERVI�JN 2 6 2022
BUILDING.& ZONING DIVISION St,Lucie coup
2300 VIRGINIA AVE Perrrtlttinp ri
FORT PIERCE;FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLA'YON OF PERMIT
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$56.00 fee for the change of Contractor.
l CHANGE OF SUBCONTRACTOR—Subcontractor changes.are to be completed by-the general.contractor.
�h�en`ew subcontractor most fill out a Subcontractor.Agreement Form.There is a$50.00 fee for the Change of Sub-
_' Contractor.
CANCELLATION OF PERMIT--The cancellation of a permit is acceptable only if na 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
j cancellation of the permit.
r
Date: I{l� ac� Permit Number;
Site Address• I �lJ �J1TC: A
State License SLC License
OriginaWC,subcontractor or owner/builder
3'7, L -QC.M, C- U� .S• l WIC State LicenseM bOQ a 55 LC License 255
j New GC,subcontractor
J) Reason for Cancellation:
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 contra to celiation of permit.A permit cannot be cancelled if work has been performed.
ATURE OF OWNER or,olvne�IQL
r/buitder) SIGNATURE GENERAL CONTRACTOR(or new GC,az appGt able)
PRINT NAt9E�IC.1V PRINTNAMEThomaS A. Tacconelli
State of Florida,County of St..Luce County State of florida;Countyofst."Cie County
The.following in wntent was,acknowledged before me this Hewing!,Rpment%ices acknowledged bey`/re me this
dayof H ,20??by I-lal� ly 2 day ofQPf�.20Ai by—�rrui{�#-k l4o
�►.y who is personally known to me f 1s GCO Al e-i' 1 who is personalty known to
has'pioduced as w me or who has produced L*(J6# as ID:
Signature ol otary Date S1gna co1Notary Date
�p i�• NANCY i SHEA. a�,p,,,,
Revised 04/15/16 � No►aryRtbltc-Stateolilorlta: ��Ati ;•; JOSEPIIpHORTER,
• Commission#NH 209)SS t+r t+Z MY CpA(M1SSlpN#GO Ay Comm.Expires?ec 19,2023 `• EXRiIt ��
a note Assn, a"ao, roe;°• ES:J60
une 1,2023
Bondsd throuih National, ry Bonded Thro Notary puW UndmM M
i
PERMIT fI a` ISSUE DATE
PLANNING & DEVEL,OPMIENT SERVICES
i Building & Code Compliance Division
BUILDING PERMIT EECEWED
SUB-CONTRACTOR AGREEMENT JAN 2 6 2022
St,; aJcie Chun
PF,`fll�flkc� ry
Steve's Electric of South Florida, Inc. have agreed to be
(Company Nat Individual Name)
the Electrical Sub-contractor for Tom's Mobile Homes
(Type of Trade) (Primary Contractor)
For the project located at 7868-,Carlton Rd Parcel ID#3228-600-003-000/2
(Project Street Addressor Property Tax ID#)
It is understood that; if there:is any change of status regarding our participation with the above.mentioned
project,the Building and Code Regulation Division of St. Lucie County will,be advised pursuant to the.
filing of a Change of Sub-contractor notice.
CONTRACTOR SIGNATURE cQue�icr SUB-CONTRACTOR SIGNATURE
(Qualifier)
Thomas A. Tacconelli Glen Abbott
PRINT NAME r PRINTNAME
EC13009955/
COUNTY CERTIFICATION NUAIQER COUNTY CERTIFICATION NUMBER
�tdcle State of Florida,County of St.Lucie
State of Florida,County"of�_.
98th
The foregoing Instrument was signed before me this Z�day of The foregoing Instrument was signed before me this^day of
wvo►4r( .zOJ by 7i�l°++��5 ��'ce-o je k January ;�t�a'by Glen Abbott
who Is personally known%r has produced a /y6/N.5- who Is personalty known or has produced a
as identification, as enti"ca"on,
�,oI�— STAMP STAMP
S(gna of Notary Public �! S gnature of of ry ubl c
Amy Alexander
Print Name of Notary Public Print(dame of Notary Public
JOSEPH P.HORTER Notary Public Stet®of Florida
?� �= t�YCOMMISSION#W297668 , A y�ynn Alexander
tq FO(F8RE3:June 1;2423 3mmlpton
Revised W1612616 ,+f.F,`o�;' III xp.1 11112
P,,,I,,• ®ondodThruNotaryPubHcUndornifiets
Exp.lO/ff/2D25
6
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. I �YON RECEIVED
:
JAN 2 6 �2022
St..Lucie County
Permitting
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