HomeMy WebLinkAboutChange Of ContractorPLANNING & DEVELOPMENT SERVICES
. ''`t ''"' BUILDING & ZONING DIVISION .
2300 VIRGINIA AVE AcElvL..
FORT PIERCE, FL 34982 MAY 0 5- 2022
(772) 462-1553 FAX 462-1578
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
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 signedand notarized by both the owner and qualifier of. record. There is no fee for
cancellation of the permit.
Date: 3/29/2022 Permit Number: 2109-0520
Site Address•
WYNNE BUILDING CORP. State License SLC License 8898
Original GC, subcontractor or owneribuilder
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/subcontrac r-or cancellation of permit. A permit cannot be cancelled ' work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENEIFAL, CONTRACTOR (or new GC, as applicable)
PRINT NAME MATTHEW LYLE WYNNE. PRINT NAME MATTHEW LYLE WYNNE
State of Florida, County of St: Lucie County
The following instrument was acknowledged before me this
_day of Inn . 20 3' 4_) by MN--'Y'E YNNE
X who is personally known to me
or who has.pr uced as ID.
3/29/2022
Signatu of Notary. Date
Revised 09 5 C1k5;PG94� DOROTHYAW) BASKIN 41
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MY CO,%NISSION # HH 045443
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EXPIRES: October 2, 2024
Bonded Thru Notary Public Undenwitterst
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
'-dayofl'77i sPCs/,20-2 .MATTNEwLYLEw(NN,
X who is personally known to
or who has pro ced as ID.
29/2022
Signature of tart' Date
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MY COMI'AISSION # 1IH 04593
' EXPIRES: October2, 2024
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PLANNING & DEVELOPMENT SERVICES
BUIMI g & Code Comp4ance Division
B131 ING IPERNJT
RECEIVED
MAY 0 5 2022
St �Mgounty
ing
GOLDSTAR ELECTRIC, INC, have agreed to be
(Comp=y Name/i�p ivjdx�a� Na=, ,)
the ELECTRICIAN Sub -contractor for WYNNE DEVELOPMENT CORP.
(Type OfTra&)
For the project located at
(Project
(PlimmY,, Contractor)
air Property Tax ID #)
It is understood that, if *ere is Many changi of status reprding our participation with the above mentioned
project, the Building and Code Rogulatton .Diviswon of St. Lucie County will he advised pursuant to the
Ping of a Change of Subcontractor notice.
Co3ltT ACTOR OWNATUU (Quaiifler)
MATTHEW L'YLE WYNNE
PIt!. NT MANE
COUNTY CiEtII:T1IF[CA J+1�7ft
Staft of *Fjor.14 County*u ST LUCIE
The foregoing insttitment Bras sig+aed before we tbis:;K t dayor
MAiTHEW LYLE WYNNE
who Is Pcrsomly !mown —Ar bas Produced a
ON identl6sation,
DOROTHY BASKIN
PctintName ,ofmoh" FabBe
DOROTHYANNBASKIN
,= MY COMMISSION # HH 045443
EXPIRES: October 2, 2024
Bonded Thru NaM
�9���—• ry Public Underwriters
PuMsed W16aQ16
10—C Bill PACTOkSIGNATURE (Qualifier)
.JOHN CAVNAR
PRINT NAI M
EC13002082
CliVWV Ct;it3`I(FTCATIaI N 71i%JildlitER
State of irlorida, County .of ST. 'UiCIE
The foregofnglnstrument was signed before the this day of
-�-,kcAr',V\ QQ y JOHN CAVNAR
Who is Personaily Itnoaru or has Produced a _ Is Ue I V Cis 1,s ovws "
as identlficitton.
STAMP
SignatoreofNptary' u tc
DOROTH'Y BASKIN
PrintName of Notary Public
a1sErr
ANN BASKIN
MYCOMMI881ON # HH 046443
, EXPIRES:October2.,2024,ondeThru Nolaiy public Underwriters
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