HomeMy WebLinkAboutCHANGE OF CONTRACTORt.
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION - RECEIVED
2300 VIRGINIA AVE MAY 0 5 2022
FORT PIERCE, FL 34982
St. Lucie County .
(772) 462-1553 FAX 462-1578 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. .
Cancellationof 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: 3/29/2022 Permit Number:
2109-0631
Site Address:
WYNNE BUILDING CORP. State License SLC License 8898 .
Original GC, subcontractor or owner/builder
GOLDSTAR ELECTRIC, INC. State License EC13002082 SLC License
New GC, subcontractor
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/subcontractor or ncellation of permit. A permit cannot be cancelled if wo • been performed.
SIGNATURE OF OWNEI (or owner/builder) SIGNATURE GENERAL CONTRACTOR'(or new GC, as applicable)
PRINT NAME MATTHEW LYLE WYNNE prNAME MATTHEW LYLE WYNNE
State of Florida,. County of St. Lucie County
The following instrument was acknowledged before me this
day of MA RC61. 20_2aby Mq_EW LYLEYNNE,
X who is personally known to me
or who has roduced as ID.
- 3%29/2022
Sign re of Notary Date
DOROTHYANN f3ASKIN
Revised 04/ MY C0h4`Ji!SSICN#HH0=15443
�= EXPIRES: Octcber 2, 2024
_bonded Thru Notary Public Unden+riters
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
-day of /✓1.4C W , 20,aa by-7H---Y NI.
X who is personally known to
me or who has produced 0as ID.
/29/2022
Signatu f Notary rDat�r s "
r'",5; , DOROTI-IYANN BASKIN 6
gib,••' ••.;oa.
MY COMMISSION # HH 045443
c , r EXpiRES:.O'tober 2, 2024
T...,.
�'F,;,`• > . [?r, dsd Thru Notary 1'ub!ic Undenvliters
PEWIT#
PLANNING & DEVELOPMENT SERVICES
Building & Code Comp4ance Division RECEIVED
RVILDING. PERNIJIT MAY 0 6 2022
OV8-CONTRACTORAGREEMENT St.. 4L"Iffin"91,111(y
GOLDSTAR ELECTRIC, INC. have agreed to be
(CompauyName1IndivWWNa=)
the ELECTRICIAN Sub -co for WYNNE DEVELOPMENT CORP.
(Type of Trade) .... - 1pzimary rnuftant'nel
For the project located at
,(Project Street Address or Property Tax ID
�It's Understood that, if there Is 30Y cbaagi Of status r'PWdin94Durp8AiCiPafiO1l with the above mel[tiOned,
project, the Budding and Code RegoUltion Division of St. Lucie County will be advised pursuant to the
filing of a Cbmge of Sub -contractor notice,
CoNMCr0jtSIGNATURE (Qu3W0r)
MATTHEW LYLE WYNNE
PRJNT t"MF
COUNTY cma"C'&TION NUMBER
State of Florida, county of SL LUCIE
The foregoing faWumentwassigned before me tbis26 dayof
�k 0-r C� \ 4 Qa,y MATTHEW LYLE WYNNE
who Is personally known -i6r bag produced a
DOROTHY BASKIN
primtName of Notary Public
DOROTHYANN BASKIN
My COMMISSION# HH 046443
EXPIRES. October 2, 2024
Bonded Notary Public Underwrlters
111,-CONTRACTOR SIGNATURE (QuAfter)
V
JOHN CAVNAR
PIUNT NAME
EC13002082
COUNTY CZ=W1CATl0NN"ffJ—ER
State of Florida, County of $T-WCIIE
The (M991ingiinstrument was signed before me tbis 0( 1 da
yof
y--kas-c-AN .201 2�jy JOHN CAVNAR
who Is personally $wown Ar bas produced a _12 ue I ve-xs 1,0 cvwse
asix1rudo"40A,
STAMP
sivature Of 1%41i' ub ic
DOROTHY BASKIN
r-rint Name of Notary
NN IN
DOR01-1
Fy
My COMMISSION F '443
H 01416�,
EXPIRES - Oct
001`2 2024
.to,
—!OnLed Thru Notary tj
211C Underwriters