HomeMy WebLinkAboutChange of Sub- ElectricPlanning & Development Services
Building & Code Regulations Division
2300 Virginia Ave.
Fort Pierce, FL 34982
(772)462-1553 Fax 4624578
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: rie ova- Permit Number:
Site Address:
APPEX ELECTRIC
Original General Contractor (or Subcontractor)
JGE II INC
New General Contractor (or Subcontractor)
Reason for Change Poor Performance
License Ec13Dos343 SLC License
ER13D75398 SLC,' L1CeriS0 31148
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,psult of this change of contractor/subcontractor or cancellation of
permit. A permit'ca t be c Celled if work has been performed.
_
SIGNA OF OWNE V (or owner/builder) ° SIONATUR .OF NEW OBK RAL CONTRACTOR
State of Florida, County of St. Lucie County
2.
The fol lowing instument was acknowledged before me this
day of h� , 20;12,
Abnxl �O wbo is personally know to me
r who has produced s ID.
Signature of Notary Date
* �; gga� re uired for change
'"r" •"'" SHANNONMITTLER
a MISSION#GG203869
ML
EXPIRES: June 11, 2022
ded Thou Notary Public UMenvdters
FRRVT NAME JOHN GAZDACKO
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me [his
ayof r-p ,b , 2Qz2.by�,jl'%�Ll—_
( 04 * 1e 7i who is nersonall�v know tome
ho has produced as ID.
Signature of Notary Date
of subcontractor SHANNONMITTLER
MY COMMISSION # GG 203869
• EXPIRES: June 11,2022
Bonded Thm Notary PVNIc Undenmters
SA I J'_ i=
•
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILllING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
the `Ar;42irj Sub -contractor for : L er'D e S
(Type of Trade) (Primary Contractor)
For the project located at
or Property Tax ID #)
It is understood that, if there is any change of status regazding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
fi
ling of a Change
notice.
COUNTY 'ERIWICATION NUMBER
State of Florida, County Of .& 1 .(A Ca C�
The foregoing instrument was sir ed before me this Z day of
k1 D 52ZZ by AW
who'sor has produced a
' eotifi�c1atio1o'j.'
l.rl. tau
gnature of Notary Public
Print Name ofNotaryP blic
Revised 11/16/2016
SUB-CONIPACTOR SIGNATURE (Qualifier)
Jdk4 l�ZQ4CJLt'1
PRINT NAME
3 ttt-E �
COUNTY CERTIFICATIONCN`UMBER
Shitc of Florida, County of f }} I i ALZ lz�
The foregoing instrument was signed before me this - dray of
r� 2( by 9 ,I**i]_6R Z �a�� -ro
who is personally known _or has produced a