HomeMy WebLinkAboutChange Of ContractorPLANNING & DEVELOPMENT SERVICES
:` -► BUILDING & -ZONING DIVISION. REcI=_IVED.
COUNTY 2300 VIRGINIA AVE. "
FORT PIERCE,. FL 34982
MAY 0 5 2022
(772) 462-1553 FAX 462-1578" st. Lucie County
Perm"*'.,.
CHANGE OF'CONTRACTO% 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.:. 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 fillout a Subcontractor Agreement Form. There' is a '$5.0.00 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: 2107.0895
Site Address:
WYNNE BUILDING CORP, State.License SLC License 8898 .
Original'GC, subcontractor or. owner/builder
COLDSTAR"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 are of 1�11S• change of.
contractor/subcontrac r-or cancellation of permit. A permit cannot be cancelled ' ork has been performed.:.: '
SIGNATURE R or owner/builder
SIGNATURE GIRAL CONTRACTOR (ornew GC, as applicable) '.
PRINT NAME MATTHEW LYLE WYNNE. pR�jT NAPE . MATTHEW LYCEMNNE " .
State of Florida,. County of St. Lucie County
State of Florida; County of St. Lucie County
The following instrument was aclmowtedged:before me this
Q� The. followinginstrument-was ac
. G M4MEw�nE rxNe. wled ed before me t
kno g his "
�L.day bf i% fl � /% 20��by ,-�1 day of � At Ci/ 20�� by ryum
X who is personally known to me" X
or who has oduced who is personally known to
as ID. a or who s pro ced as ID. -
3%29/2022
Signa of Notary." Date
3/
Signature f ota
29/2 -
:y .. Date
Revised 09/1 1,6,�P PL DOROTHYANN BASifIN °`�RYP�� FIYA�f ggSKH "
3 � h hIY COMB ISSION /# HH 045443
* *. MY COMMISSION # HH 045443 )ty *_
:F '?Q;�o FrYPIRF..S; October
2,,2024 'r oFF`°�°` EXPIRES: OotOC)e12,2024.
oFr:..•'Bonded Thru Notary. Public Underwriters .Bonded Thru Notary public lipdenwriters
t
166UFz DATE
PERMIT#
PLANNING & DEVELOPMENT SERVICES
BuDding & Code CompHance Diviston 'IECEIVED
RVILDING PFRMJT MY 0 5 2022
SUWCONTRACTORAGREEMENT St, Lucie County
GOLDSTAR ELECTRIC, INC. have agreed to be
(Comp=y NamefindividiW NA=)
the ELECTRICIAN .... Sub.cojltr"tor for WYNNE DEVELOPMENT CORP.
(Type (himary, 6n �actor)����
For the project located at
(t'A9)eett< address ar Property T= ID
It is understood that, if *ere is my ehangiof status rWdingour participation 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,
CONFUACTOR SIGNATURE (Quallllflej?) ROB-CONTRACTOR SIGNATURE(Qualifier)r
MATTHEW LYLE WYNNE
COUNTY CERTIRCA'"ON N"Ea--
State offt*%Cquntyaf. ST. WCIE
The foregoing lndntmentwzxigoed before we tbls2k I Aayof
N�,k CXJA 02 a.by MATTHEW LYLE WYNNE
who & pmonany known -Zar has produced a.
as wentiffra"
LWO la�01W-V; STAW
skeature of M114K561i, , -,--
DOROTHY BASKIN
?#11nt Name of Notary ftbfig
DOROTHYANN BASKIN
:*1 My COMMISSION # HH 045443
EXPIRES: October 2 2024
Bonded DiruNalarypnhimUnderwriters
JOHN CAVNAR
Pluf NT NAIME
EC13002082
COWTV CERWICATION N(NWJ—ER
Stateof FWA4 conntyof ST. LUCIE
C,
day
\I-kCky-C,ir\ 2O�y J OHN CAVNAR
STAMP
DOROTHY BASKIN
raniNameefRotary Public
"W,
�Y A—,'q
7
DO
DO ROIT)YANN 13ASIVN.
MYCOMMS,
COMMISSION
tl Ilf"I 045
F'PI MISSION # H[i 045443
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RE 02
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b'
ru
!Pbic Underwriters
EXPIRES: October 2 2
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Id Thru Wary
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Public Undoiwate