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HomeMy WebLinkAboutChange of Contractor, ELECTRIC, 4.12.22of NA PERMIT � # ISSUE DATE co -- PLANNING & DEVELOPMENT SERVICES9 Building & Code Compliance Division � I BUILDING PERMIT SUB -CONTRACTOR AGREEMI ENT i L� ���-�� • have agreed to be (Company NamUIndividual Name) the Sub -contractor for Q (Type of Trade) (Primary Contractor) For the project located at SDJC.2Q,1 IJ vVG� y (Project Street Address or Prope ty 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 3122D COUNTY CERTIFICATION NUM�BER� State of Florida, County of&- _k1 Cy C, The foregoing instrument was signed before me this 1 7— day of 2o2y 1 who is personally know, 411- _or has produced a STAMP gtT"r' . 'ASHANNON W%ER€.: SION # HH 227893 P�: June 11, 2026 Revised 11/16/2016 "•;f'iiFi;°•`'1 c SUB -CONTRACTOR SI73NATURE (Qualifier) � T, I PRINT NAME / f CGS 15 0 �17' COUNTY CERTIFICATION NUMBER State of Florida, County of `^d�!_L'W� 7 The f regoin instrument was signed �before me this � day of 1 20-Lb, ' 1 /vrnLL� ���A who is personally known has produced I a ide ification. STAMP Sig 6ofNotary Public 111� Print Name of Notary Iublic SHANNON MITRER MY COMMISSION # HH 227893 �•'.;roF;�o? EXPIRES: June 11, 2026 a�a�>Wo � � ^� `~`~`� �� }e�� ƒ� � � :Asp »c;lam � �� �� ��� �,c � �� �' � m � } \x�� � K {& , « �©'� zi KKae, � <� � : �t�� w: >»: z' uza« . . } � \\�:` a� � emu�� ~ $ /J\� y)�%�� e�RVWs�vl§ � �~ ®�.� � � , � � ) � �� y / ®,� m� � R RC � � \ � a��� =Awe � >�� G� \ a�� 3z�� z� � iv�»���� § PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION y� 2300 VIRGINIA AVE 410 ��/G�o FORT PIERCE, FL 34982 Sri �2 (772) 462-1553 FAX 462-1578 CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT I i 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 thaw,�$2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to Comm cing any work. There is a $50.00 fee for the Change of Contractor. V CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor. The new subcontractor must,f ll 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,' feed for cancellation of the permit. Date: '3131 aa` Permit Number:-.?, `0 A— 0 `,`-Q'� Site Address: State Licens�270436 1s9Z) SLC License New GC, ubcontractor 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/subco r cellation of permit. A permit cannot be. c ncelled if wor has been p � ormed. 0a' IGNAT OF OWNER (or owner uilde) SIGNA GENE ONTRACTOR (or as applicable) 4 PRINT NAME Q PRINT NAME f rL`�ft� GGi State of Florida, County of St. Lucie,County The following' was ackno Awledged of me this day of 20 — by L - n who is personally known tome or who )>duced _ n _ as ID. Signaturof Notlity I I ''' Date Revised 04/15/16 44'M°O,'''f',- JOYALIPPARD :; Commission # GG 236838 a' ate: Expires August 4, 2022 F�1���,' Bonded Tluu Troy Fain Insurance B00.3W7019 State of Florida, County of St. Lucie County The following i tru t was acky,. vl 4ed be re me this �. ' day of r 1 201`—l� . by Dama(� D' who is personal) own to me or who has p o ce as ID. Signature of No ate „•;�a;, JOYALIPPARD Commission # GG 236838 ? Expires August 4, 2022 �P PF Bonded Tfau Troy Fain Insurance 800.385-7019 . Y-Q Moved %T41,71