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HomeMy WebLinkAboutChange Of ContractorPLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE RECEIVED FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 MAY 0 5 Z02Z 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 commencingany 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: 3/29/2022 C Site Address: WYNNE BUILDING CORP. Original GC, subcontractor or owner/builder GO..LDSTAR-ELECTRIC, INC. New GC, subcontractor Reason for Cancellation Permit Number: 2110-0715 License - SLC License 8898 License EC13002082 SLC License 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/subcontracto or cancellation of permit. A permit cannot be can if work has been performed. SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable) PRINT NAME MATTHEW LYLE WYNNE State of Florida,. County of St. Lucie County The following instrument was acknowledged before me this �q day of 4CW 20 7a by �""nHeNLriEYNNE. x who is personally known to me or who has pro uced as ID. 3/29/2022 Signatu e f Notary Date j o<�^y°°< • DOROTHYFlNN E3FlSKIN Revised 04/1 �fJJ b'' *; MY COMMISSION##HH045443 �. • - ,;. o` EXPIRES: October 2, 2024 FOF�OP Donded Thru Notary Public Underwriters PRINT NAME MATT -HEW LYLE WYNNE State of Florida, County of St. Lucie County The following instrument was acknowledged before me this _Z�day of a 40C4./, 20,M by """TTM-"' —NI X is personally known to e or who has pr iuced . as ID. 3/29/2022 Signature otary 1 � TM DOROTHYANN •�o<'SY°�?i� i3ASKIN MY COMMISSION ;# HH 045443 EXPIRES: October 2, 2024 Dorded Thru Notary Public Urdenvriters F PERMrT# \ s © ri ISSUE HATE PLANNING & DEVELOPS FNT sER ic-E; Building & Code Comp fiance Division BUILDING PERMIT $VB-CONTRACTOR AGREEMENT MAY 0 5 2022 8 tope coun� PermftNnO y GOLDSTAR ELECTRIC, INC, have agreed to be (Compny Name/iedivisa 'N) ELECTRICIAN sub -contractor for WYNNE DEVELOPMENT CORP. (Type Of Trade) For the project located at (—Q N Q (Projmt Sir (Primary Contractor) or PTopegy'T= ID #) It is wn&rstotod that, if *ere is my change of status rpgardiog lour participation with the above mentioned project, the .Building and Code Reguiation .Division of 3t. Lucie County will be advised pursuant to the filing of a Mange of Sub -contractor notice. CfM.AC; 0.111 SIGNATM (guano) SJDBCA�TTIiACTDIi SIat;iNA3 URE (Qualifier) MATTHEW LYLE WYNNE PBItdiT biAME 08898 I1iNTY CEiiT'd A CATION 1litll<MBEIt State ofFlorida,County of.ST,LUCIE "rho forepinsg instrument Was signed before me thia';K ` day qp wbo.is per sadly known JeL'or has Produced as as identilisa"n. S;Vature of wo,' oli DOROTHY BASKIN Ptiat Name ofNotuyPsoblie DOROTHYANN BASKIPI ; _ MY COMMISSION ## HH 046443 �9;�!��.;o• EXPIRES: October 2, 2024 '`° Bonded Tliru Notary Public Underwriters 7�canaa�nw:fi5u.�ce n�,�,�;cra�„rr�a „ublicUnde Revised 11i16>20l� ,JOHN CAVNAR EC13002082 COUNT CERTIFICATION iYU1'IfiE111 State of Florida, County of ST. ILUCJE The .foregoingunstrument wnssigned before me this1p da y of ,S�ckrc�,I ,.QNy,JOHN CAVNAR Who is personalty itnon'n _or has Produced a ss 1dentiIIcatl'ox STAMP Si0natureofIlNotary' ub C ©OROTH'Y BASKIN PrintName of Notary public g[*ao _rxrwtis�t��woaw_�t�,c�e: N,f;YnnP/ipG,, DOROTHYANN f3gSKIN t a � k' MY COMMISSION ## 1-IH 045443 opo EXPIRES: October 2 2024 _ Bonded Thru Notary public Undervuriters LLuaYc,tvY,�y®xray�r�r�-M.� a�:sa�ij�✓x`:.tid>`