HomeMy WebLinkAboutCHANGE OF SUB-CONTRACTORyl
SCANNED
BY
PLANNING='DMAPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIV66
FORT PIERCE, FL 34982 JAN 0 7
(772)462-1553 FAX 462-1578
Permitting pepartme,
St: Lucie Cnr,�t,.
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 jo alues greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
com encing any work. There is a $50.00 fee for the Change of Contractor.
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: i Permit Number: Z CJ 6 2 S '7
Site Address: 2- 9 0 09
. State License (64 6 f l i'S SLC License 2e436 3
Qiginal GC, subcontrac rroor owner/builder
C, v State License' 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 m arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if s been performed.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_ by
who is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
SIGNATURE
new GC, as applicable)
I aro{ I•y
State of Florida, County of St. Lucie County
The following instrument was acknpgledged of re me is
�
20 by
I4 lA in i/l ��l � wh������77777(
` is personally known
e or who has olkteed-1 a
of
Rebel` pima
Bonded
PERMIT # 962- — fj l Lj ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
ELECTRIC CONNECTION
(Company Name/Individual Name)
the ELECTRICAL
(Type of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Sub -contractor for GHO HOMES
(Primary Contractor)
have agreed to be
For the project located at MEADOW WOOD- #50 2& f3 0
(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.
CONTRACTOR
r 1l .
C vsjl L/1F
COUNTY CERTIFICATION /NUMBER/
State of Florida, County of V t ( u 6f e
The fore oing instrument was signed before me this day of
zo by 4 Q el
who is personally known _or has produced a
as
STAMP
Print Name of Notary Pubv �goa G�O�$Z6
� 9, 20�1
W .
Revised 11/16/2016
CONTRACTOR SIGNATURE (Qualifier)
RANDY SJAARDEMA
PRINT NAME
21055
COUNTY CERTIFICATION NUMBER
State of Florida, County of ST LUCIE
The foregoing instrument was signed before me this 3 day of
JANUARY , 201 2 by RANDY SJAARDEMA
who is personally known X or has produced a
as identification. (� 1P4 ��
�/---- STAMP
Signature of Notary Public
Print Name of_Notary Public
4k Li poe SITYAN T BROMELOW
?PR^` Notary Public - State of Floridata` Commission # GG 263711
''bF r�°�'' My Comm. Expires Oct 17, 2022
Bonded through National Notary Assn.