HomeMy WebLinkAboutChange Of Contractori
PLANNING & DEVELOPMENT SERVICES
BUILDING & -ZONING DIVISION RECEIVED
2300 VIRGINIA AVE.
FORT PIERCE, FL 34982 MAY 0 5 2022
(772) 462-1553 FAX 462-1578 St. Lucie County
Permittino
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.
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
Permit Number:
Site.Address•
WYNNE BUILDING CORP.
Original'GC, subcontractor or owner/builder
GOLDSTAR ELECTRIC, INC.
New GC, subcontractor
Reason for Cancellation
2106.0735
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/subcon rvr cancellation of permit. A permit cannot be canoe a work has been performed.
SIGNATURE.OF OWNER (or owner/builder) SIGNATURIMENERAL 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
a_day of M-4 94 / . 202A by MATT 'w'y'E TNNE
x who is personally known to me
Z
who hasp uced as lD.
or who
Signat6iof Notary Date
XrYP��' DOROTHYANN BASKIN
Revised 04/15 6:;'' *. MY COMMISSION # HH 04593
'V EXPIRES: October 2, 2024
Bonded Thru Notary Public Undemiiers
PRINTNAME MATfHEW LYLE WYNNE
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of YYl A-,e CH, 20"by IMTMEWL"F` AIN'
X
who is personally known to
e or who as uced as ID.
3/29/2022
Signatur Notary Date
o<*yP���� , DOROTHYANN BASKIN
*; MY COMMISSION # HH 045443
EXPIRES: October 2, 2024
Borded Thru Notary Public Undenvriiers
PFRMrT# SUE DATE
!E
C�(_o OVA IS
PLANNING & DEVELOPMENT SERVICES
BuiWing & Code Comp0ance Diviston
BUILDING PERMJT
KWCONTRACTORAGREEMENT
MAY 0 5 2022
St. Lucie County
Permittinq
GOLDSTAR ELECTRIC, INC. have agreed to be
(company Name/wdiod1w 'Namo)
the ELECTRICIAN Sub -contractor for W(NNE DEVELOPMENT CORP.
(Type Of Tm") (Primary contractor)
For the project located at rA -n \
(Project Street A44res or Property, Tox(D #)
It is understood that, if there is any changiof statmregarding our participation with the above mentioned
project, the Building and Code Regulation Division of St. Lucie County -will be advised purswnt to the
filing of a ClIange of Sub -contractor notice,
CONMCTQRSIGNATURE (Qua"er)
MATTHEW LYLE WYNNE
PRMT NAME
COUNTY CERUFACATION NUMER
State of FW4 Cquety *ST, LUCIE
The foregoing iostrumenteves sipedbefore metbis2k I dayof
�k CW C,\ , Qab_v MATTHEW LYLE WYNNE
who 1§ pamnavy Jww. _ZG), ft6 produced a
asidendfigadoz
DOROTHY BASKIN
Adut Name of Notaoy Pimbfic
DOROTHYANN BASKIN
.0. " * My COMMISSION # HH 045443
EXPIRES: October 2, 2024
bonded
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Its, teed ti/f�413Afb
WJO-CONTRACTOR Slew TUBE (Quagner)
1.
JOHN CAVNAR
FMNT NAW.
ECI 3002082
COUNTY CERTWICATION NUMJER
state,of Floeida, County of ST, iWCIE
The foregoing iustrumeutwas signed before the this C'( day of
JOHN CAVIN AD
Who is PMOU211Y IMOWO or has produced a 12yfl I_0C,6rN$F
as'Wendiwilox
(r A&04�— STAMP
Signowe*fNotary 1"b C
DOROTHY 13ASKf N
PrintName of Notary gb1fr
'N
-IYANN BASKI
DOROTI N
MYCO
MM'S'910N # VIH 046443
EXPIRES- October 2 2024
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