HomeMy WebLinkAboutChange Of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300. VIRGINIA AVE AECE VI. ED
.. .. ...
FORT PIERCE, FL 34982 MAY 0 5 2022
(772) 462-1553 FAX 4.62-1578
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 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: 2100-0755
Site Address: KIG\G���e'�
WYNNE BUILDING CORP.
Original GC, subcontractor or owner/builder
GOLDSTAR-ELECTRIC, INC.
New GC, subcontractor
Reason for Cancellation
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/subcontr r-or cancellation of permit. A permit cannot be cancelled if .ork has been performed.
SIGNATURE OF WNER (Or owner/builder) SIGNATURE GENERAL 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 1&11
20 b !!:! wLYLEYNNE
��Y
x
who is personally known to me
or who has pro ced
as ID.
3/29/2022
Signatur Notary
Date
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DOROTHYANN BASKIN
Revised 04/
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MY COMMISSION#.HH045443
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EXPIRES: October 2, 2024
Bonded Thru Notary Public Underwriters.
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
,,;),jday of MC / , 200. by rn^--L-E—NI
X who is personally known to
e or who s pr uced as ID.
3/29/2022
Signature o otary Date
�:'• :�< DOROTHYANN BASKIN
Xt
MY COMMISSION # HH 045443.
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EXPIRES: October 2, 2024
Bonded Thru Notary
ry Public Urdenvriiers
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PEMIT# C� ISSUE 0 ATE
PLANNING & DEVELOPME NT SERVICES
BuDding & Code CompHance Division
8131,I)ING. PERHJT
ISUS-CONTRACTORAQUEMEW
GOLDSTAR ELECTRIC, INC, have agreed to be
(Compmy NamefindivkbW Nan*)
the ELECTRICIAN Sub -contractor for WYNNE DEVELOPMENT CORP.
(Type (Pd=ry1CQntrad00
For the project located at e4>
('yoject Strpoet Aftossor Prppeny Tax ID.4)
It is understood that, if there is my changi of status regarding our partiwipation with the above mentioned
project, the Building and Code ROSAWi0n, Division of St. Lucie County will be advised pursuant to 'the
filing of a Cbange of Sub -contractor notice.
CONrRACToR6jGxATURE(Q=fit1er.)
MATTHEW LYLE WYNNE
PRINTNAMF
COUNTY CERTAFACATION NUMER ...
ftoof 0964CbaotyaST. LUCIE
The brog0bg instrument was signed before me WCK I dayof
�A c)-C
0(\_.Z��hy MATTHEW LYLE WYNNE
who Is 1perwnAy known _L61 has produced a
asidendfigadox,
$TAMP
Wife
DOROTHY BASKIN
Point Name OfN" Pabft
DOROTHYANNI BASKIN
MY COMMISSION 0 HH 045443
EXPIRES; Octob er2,2024
Bonded 1h�Not�ry Public Underwriters
Reww�d 1/6120
V00-CONTRACTOR SIGNATURE (Qualifier)
JOHN CAVNAR
'PRINT NAME
EC13002082
COVArf V CERTWICATION NUMBER
State of Florida, 4countyof, ST 1WOE
The foregoing instrument was signed before me this OZ day of
.ytiCkri✓,V\ JOHN GAVNAR
who Is P","nallY know), qr has produced a V? I V&_xS 40 C6rNZ
as idgnMatiox
c4v," A'oOJL STAMP
DOROTHY BASKIN
Print Name of Notary Public
%TntTula,
DOR01-11YANA
My(, I BASKIN COMMISSION
# I -IH 045443
EXPIRES: Octobef 2 2024
Bonded Thrt .1 N.1�,y public lindcrwriters
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