HomeMy WebLinkAboutCHANGE OF CONTRACTOR -ELECTRICIANPlanning & 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 comp le#ed 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: L?G } I/a Permit Number: I iw/
Site Address:
APPEX ELECTRIC
Original General Contractor (or Subcontractor)
JGE II INC
New General Contractor (or Subcontractor)
Reason for Change Poor Performance
iEc13e09343 SLC License
State Lcense
License ER13015398 SLC. License 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 result of this change of contractor/subcontractor or cancellation of
,York has
State of Florida, County of St. Lucie County
The fallowing inshument was acknowledged afore methis
da of �. 20�by
who ispersonalty know to me
\may or who has cad as ID.
`.�}�YJI
Sign
atm�e of Notary Date
been performed.
°S10NATURJ;OIr N)i�x WGGYJ M CL OiJTRACTOR
PRINT NAM& JOHN GAZDAGKO
State of Florida, County of St. Lucie County
The following in(s�trument was acknowledged befor me this
Zday of_ ('Q_1, , 20�by_�Qj_�
�7, c L� Je O who is personally know to me
or who has produced as ID.
z-
Signature o£Notary Date
*Only signature required for change of subcontractor
neoinel ay/u/ SHAND�ON MITRER
e MYCOMMISSION B GG 203869
Pi EXPIRES: June 11, 2022
Bond ed pu, Notary Public Undatwdters
•I;�r"�. SHANNON MITTLER
; MY OOMMISSION H GG 203869
=.ems P; EXPIRES: June 11,2022
BondedIwl Tnru Notary public UnilLe ero
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
zuzzvzNG ri;z�tvzzT
SUB -CONTRACTOR AGREE, 1ViENT
(/Co/mpany Namelindividual Name)
the C ! Cr f T ! i ran Sub -contractor for
(Type of Trade)
For the project located at — ` Q t U M q Ct7)<E' DY
(Project Street Addr s or Property Talc ID
have agreed to be
rob �ro�erj2e�s
(Primary Contractor)
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,
COtWff ICLRT'IFICATIONNUM M
State of Florida, County of OL
The foregoing instrumentwas signed before me t � day of
QAO 2�by VN.(at�L W\,�
who is personalty known or has produced a
STANLP
SUB-CONTPACTOR SI TORE(QuaMer)
�okn %zd�rl-'
PRINT NAML
COTTNTY CEXTIFICATIONNIUINffiLX
Statc of Florida, County of 'f" LtLLC
The foregoing instrument was signed
� before me this � day of
Q/b 20� J fi� n (9
who is personally knmrn or has produced a
;tn." `•�;; SHANNON MITTLER ;za""'Y°`�;- SHANNON MITfLER
_ MY COMMISSION # GG 203869 MY COMMISSION # GG 203809
Revisedil/16/2016 `"'� Z'Nm' EXPIRES: June 11, 2022 +.t a�°" EXPIRES: June 11, 2022
pro ilk bonded Thw Notary public Undemrfters '' Bonded Thm Notary Public UndeWters
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