HomeMy WebLinkAboutChange Of Contractor�.
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PLANNING & DEVELOPMENT S:
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FOIST PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLEASE SELECT ONE OF THE FOLLOWING:
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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.
1--im 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: 9/4/2018 Permit Number: 1711-0144
Site Address: 3108 Yellowstone Circle
Sea Breeze Electric State License SLC License
Original GC, subcontractor or owner/builder
Peay's Electric II, Inc State License ER13014555 SLC License 30013
New GC, subcontractor
Reason for Cancellation Sea Breeze left Job
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/ bcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) ATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
4 day of September ,) 1a by
personally known who is personally known to me
or who o ed as ID.
���,� 9/4/2018
Sigoa oR.tary Date
Revised 0
=o.,p y Pug, Notary Public State of Florida
Sandra Leone
N� c� v My Commission GG 020251
'4oFpo@ ExpiresoB/10/2020
PRINT NAME Christina Slate
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of Sews• x= 20 1e , by
personally known who is personally known to
me or w s roduced _as ID.
9/4/2018
Signa a of Notary Date
e rod RY °ugG�
Notary Public State of Florida
Sandra Leone
My Commission
tL` oFrLo
GG 020251
Expires08/10/2020
PERMIT # ISSUE DATE
1711-0144
PLANNING & DEVELOPMENT SER
Building & Code Compliance Divi
BUILDING PERMPI'
SUB -CONTRACTOR AGREEMENT
SEP 5 2018
Permitting Department
St. Lucie County, FL
Peay's Electrical have agreed to
(Company Namellndividual Name)
the Electrical Sub -contractor for D R Horton Inc
(Type of Trade) (Primary Contractor)
For the project located at
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change 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
filing of a Change of Sub -contractor notice.
�4
CONTRACTOR SIGNATURE (Qualifier)
Brian W. Davidson
PRINT NAME
CRC 1327068
COUNTY CERTIFICATION NUMBER
State of Florida, county of Brevard
The foregoing instrument was signed before me this 5 day of
September , 20 8 by
who is personally known yor has produced a
as identification,
STAMP
Signature o otary iffublic
Print Name of Notary Public
ov PUB` Notary Public State of Florida
Revised 11/16/2616 = ® Sandra Leone
c, or My Commission GG 020251
OFtvop Expires08110/2020
U8-CONTRACTOR SIGNATURE (Qualifier)
Christina Slate
PRINT NAME
ER13014555 / 30013
COUNTY CERTIFICATION NUMBER
State of Florida, County of Brevard
The foregoing instrument was signed before me this 5 day of
September ,2018by
who is personally (mown _X_or has produced a
as identification. ,,�
---------- Lz2v4//e /�
STAMP
Signature of Notary Public
Print Name of Notary Public
aoA, Notary Public State of Florida
Sandra Leone
My Commission GG 020251
q�of Ve Expires 08/10/2020