HomeMy WebLinkAboutChange Of Contractor� e a
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
Permittinci
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: 2109-0523
Site Address:
WYNNE BUILDING CORP.
Original GC, subcontractor or owner/builder
GOLDSTAR ELECTRIC, INC.
New GC, subcontractor
License SLC License 8898
License EC13002082 SLC License
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/sub c /or cancellation of permit. A permit cannot be canoe or has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GER9RAL CONTRACTOR (or new GC; as applicable)
PRINT NAME MATTHEW LYLE WYNNE PRINTNAME MATTHEW LYLE WYNNE
State of Florida,. County of St. Lucie County
The following instrument was acknowledged before me this
day of Q Cti 20_?.by MATTHEW LYLEYNNE
x who is personally known to me
or who h pro ced as ID.
�Dat.
3/29/2022gna
Sie f Notry
..........
PAYPaDOROTHYANN BASKIN
Revised 04/1 1.jV * MY COMMISSION#HH045443
• g EXPIRES: October 2, 2024
lF�Fp�°e Bonded Thru Notary Public Underwriters
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_J_ ,day of M 4XCII , 20,M by xurrNEw LnE wrt�N
X who is personally known to
me or wh has duced as ID.
3/29/2022
Signat Notary �DatG
;o«NVP°G�.� DOROTHYANNBASKIN"., `
;.; 045
MY COMMISSION it HH 443
Am
EXPIRES: October 2, 2024
Bonded Thru No ry Public Underwriters
IPcERMrT # 0-S e� 18611E0ATIF
PLANNING & DEVELOPMENT SERVICES
891MIng & Code Comp ante Division
BVILDI NG PERN..XT
SVWCONTRACT'Ott. A+GREEMENT
RECEIVED
MAY 0 5 2022
St. Lucie County
Permittlno
GOLDSTAR ELECTRIC, INC. have agreed to be
(company Name/il]dividnal Namo)
the ELECTRICIAN Sub -contractor for WYNNE DEVELOPMENT CORP.
(Type OfTraa) (kmary Contractor)
For the project located at
It is understood that, if there is any cbangi 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
fiflug of a Change of Sub -contractor notice.
C!odINYRA.CTOR SIGNATURE (Q=Uaer) �VDCONTRACTOR SIGNATURE (Qualifier)
MIATTHEW LYLE WYNNE
PRINT +NAMF:
�f�•t.S
COUNTY CEii"RCA'I'IAN NUMBER -
State of Florins, County of ST LUCIE
The foregoing instrument was signed before we tWA ` day of
4�• ,ty MAT HEW LYLE WYNNE
who i§ per ona]ly known —Qr Ilas prodiwd a
as idendruadon,
t4r�eofi' qg , i ue
GL�7tAiP
DOROTHY BASKIN
Print Name ,of Notary 'Public
.ao ^�v+wkm+ma��
DOROTHYAPiP16ASma*aaa
KIN
�_.!�.•;°`.;
MY COMMISSION # HH 045443
EXPIRES: October 2,2024
Bonded Thhru Notary Public Underwriters
sed l]/td/3Q]6
.JOHN CAS NAR
PI0, NT NAME
EC13002082
COUNTY CI;RTIFICATJON il1�J1 Bk_R
State of Florida, County of ST. WCAE
The foregoing instrument was signed before !me this�kdyof
asi✓� .,zonyJOHI'a+9 CAVNAR
WINO is persoaatiy is iown nor has produced a !1,/ tR 8 V"s
asidendfleaWn,
6"4,STAMP
Signatura of Notary' ub is
DOROTHY BASKIN
PrintName of Notary Pubic
r ;waaszmmyyny�,zcc�2wu .
;5 . •,<<;. DOROUIYANK BAS{QN
e a raj• _ MY COMMISSION # HH 00443
;Y:
3 0o EXPI ^
RE,:Oct06er2,2024
Bonded Thru Notary public Underwriter
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