HomeMy WebLinkAboutChange Of Contractor-- PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
• 2300 VIRGINIA AVE
FORT PIERCE, FL 34982 RECEIVED
(772) 462-1553 FAX 462-1578
MAY 0 5 2022
e oun
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATI&M419 T
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.
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: 0/20/2022
Site Address -
Permit Number: 2109r0528
WYNNE F)LIII-DING CORP, State License SLC License 8898
Original GC, subcontractor or owneribuilder
iGOLDSTAR ELECTRIC, INC. State License I=C13002082 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/subcontra t ancellation of permit. A permit cannot -be cancelled ' rk has been performed.
SIGNATURE OF ER (or owner/builder) SIGNATURE GE RAL 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
_5?A-dayof /77AXC.4 20J- �by n'EwLrLEr...
X who is personally known to me
or who has. oduced as ID.
3/29/2022
Signa of Notary Date
Revised 04/ DOROTHYANNBASKIN
MY COMMISSION # HH 045443
EXPIRES: October2,2024
°f ,-w" Bonded Thru Notarypubi?c Underwriters k
PRINT NAME MATTHEW LYLE WYNNE
State of Florida, County of. St. Lucie County
The following instrument was acknowledged before me this
,,;L�day of 0M ,4&nf•/ , 20a_)�; by !--L--NN1
X who is personally known to
e or who has pr duced as ID.
• 3/29/2022
Signatur o Notary Dam
DOROTI-IYANN BASKIN
MY COMMISSION # HH 045443
EXPIRES: October2, 2024
r� •..
; �.•, Bonded Thru Notary Pub! ic Urdenvriter,
iPI*I1rT # — l`� S�-C� l DATE
PLA.NNING' & DEVELOPMENT SERVICES
Building & Cede CtompHance Division
BUILDING. PER. diT
$VWCONTRACTOR AGREEMENT
MAY 0 5 2022
St. Lucie Couniy
Permittinq
GOLDSTAR ELECTRIC, INC. Have agreed to be
(company Nar>r>,ellfpdavual Naw. )
the ELECTRICIAN sub -contractor or WYNNE DEVELOPMENT CORP.
(Typle Of Trado) (Primary, Contractor)
For the project located at � � � � t\'�
kProject Street A44ress or Prope;1y'Tu ID #)
It is understood that, if there is almy Changi of status regarding our padicipation 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,
CAwR4CT0Jt>SIG1gTA'TUiM (Quaii00)
MATTHEW LYLE WYNNE
COUNTY CdEIfI' MATION NUMIER
State of M44 County *f ST LUCIiE
The forogping instrument sues signed before me tbis2L ` day of
MATTHEW LYLE WYNN `
who is personany known Z r Las po oduem a
as identirwadon,
DOROTHY BASKIN
ut acnenfNotaryPubltG
anaxv,rt„t,,.
DOROTHYANN BASKIN
MY COMMISSION # HH 045943
EXPIRES: Octo
be
r2,2
Bonded Thru Notary Public Underwriters
F.evised it/i�413gi6
plyBG(f�TRACT[llt�I�3�A3'Ui2E {qualifier)
JOHN CAVNAR
FLUNT NAME
EC13002082
COUNTY CERTIFICATION NUM13ER
State of irior►da, County of. ST. 1'Ll1QE
The foregoingaustrumentwas siguedbefore me this��� day
JOHN CAVNAR
'Who is persoamlly ft0w- J --Pr bms produced a 12 VC I V &-XS Le C6WSe
= identilleakon.
6" A&0'°— STAMP
Si�uatureeofiKotary' u'b e
DOROTHY BASKIN
PrintNameof Notary Public
-�.`�..:55A4aRl•�= .2L(i6TS�ti,V7F,.G'IW�y
hrY
°�' DOROTI-IYANI\If3ASICIV
f al` s '•*; MY COMMISSION 04"v443
EXPIRES:fir
October?., 7.024
Bonded Thar Nofary public
Underwriters