HomeMy WebLinkAboutChange of Contractor -NERVICES PLANNING & DEVELOPMENT
-
- :�'. ., BUILDING & ZONING DIVISION
RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 JAN 2 9 2018
(772) 462-1553 FAX 462-1578
ST. Lucie County, Permitting
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.
CANCELLATION OF PERMIT—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: /-.2 9:J_vi S- Permit Number: 1711-0441
Site Address' 10105 Muller Rd,Ft.Pierce,FL
RK Electric,LLC State License EC13007108 SLC License 29576
Original GC, subcontractor or owner/builder
Ed's Electric,LLC State License EC0001569 SLC License 10892
New GC,subcontractor
Reason for Cancellation mutual agreement
The under 'fined doe hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fe s or da es.arising from any and all claims of action for any reason,which may arise as a result of this change of
con to/su 'c a or or cancellation of permit.A permit cannot be ancelled if work has been performed.
j GNATURE OF O (or owner/builder) SIGQofrida
ENERAL CONTRACTOR(o GC,as applicable)
/ PRINT NAME2iAn;61 R- l &_r-N A71C1r6 Z PR
State of Florida,County of St.Lucie County StatCounty of St.Lucie County
The following instrument was acknowledged before me this The llowing in ent was ackn kedged before me this
oZ 9 day ofoT U-4r 2Q/f'-,by Arni Jday of t,�,20Jby
who is personally known to me (� by rp who is personally known to
or who has producer a ar lie✓ as ID. me or wh as prodned as ID.
Signature of Notary Date Signature of Notary Date
:tPa/P�s GLORIAJ.POLIZZI KAREN S. NIELSEN
o ,- ,\
Revised 04/15/16 -'_* = Notary Public-State of Florida
�� B``-' Commission # FF 115637
My Comm.Expires Sep 30,2018 2. My Commission Expires
Commission#FF 143695 June 12. 2018
PERMIT# ISSUE DATE
1711-0441
PLANNING & DEVELOPMENT SERVICES
Building& Code Compliance Division RECEIVED
0
BUILDING PERMIT JAN 2 9 2018
SUB-CONTRACTOR AGREEMENT
ST. Lucie County, Permitting
ED'S ELECTRIC i�n C, have agreed to be
(Company Name/Individual Name)
the ELECTRICAL Sub-contractor for JDL Builders LLC
(Type of Trade) (Primary Contractor)
For the project located at 10105 MULLER RD,FT.PIERCE
-- (Project Street Address or 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.
CO CTOR SIGNATURE(Qualifier)`, SUB-CONTRACTOR SIGNATU (Qu r)
P T AME PRINT NAME p
COUNTY CERTIFICATION NUMBER COUNTV CERTMCATION NUMBER
State of Florida,County of lC� State of Florida,County of S4. 1
The foregoing instrument was signed before me this a9 day of The
foregoing instrument was signed before me this X day of
2011by'v)w 60 & 20�U,by
who is personally known or has produced a L V who is person y own or has produced a
as identification. as i entification.
Cs-- STAMP STAMP
Signature of Notary Public Signature of No Public
d1nor,I C'o-'r"
Print Name of Notary Public Print Name of N tary ublic
KAREN S. NIELSEN
HNINgi
Commission # FF 115637 ,Z STACEYGARCIA
qQ MY Commission Expires : �:� MY COMMISSION#GG085840
F� June 12, 2018 ip;'
o,. EXPIRES:May 16,2021
Revised 1 I/16/2016 41odd.a.•' Bonded ThN Notary PuW{c UndWMWrs
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