HomeMy WebLinkAboutCHANGE OF CONTRACTORRECEIVED
PLANNING
BUILDING & ,'
2300 VIRGINL
FORT PIERCF
(772) 462-1553
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR—(
and the new contractor of record for the curre.
contractor information and signature. A new/
for job ues greater than $2,500 ($7,50�0
con ncing any work. There is a $50.00 fef
NZ CHANGE OF SUBCONTRACTOR
The new subcontractor must fill out a Sub/Con
Contractor. /
UB
Lbda#jMENT SERVICES
3NING DIVISION
AVE
FL 34982
FAX 462-1578
TION
JAN 07 2019
Permitting Department
St. Lucie Countv
hange of Contractor is to be signed and notarized by the property owner,
t permit. A new permit application must also be completed with new
gotice of Commencement must be filed in the new contractor's name
if A/C Change -out). A recorded copy must be submitted prior to
for the Change of Contractor.
— Subcontractor changes are to be completed by the general contractor.
ractor Agreement Form. There is a $50.00 fee for the Change of Sub -
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:
Site Address:
inal GC, subcontra
ie 6-1- i C
GC, subcontractor
Reason for Cancellation
Permit Number:
6_ri`v ` _ 6M `ZT
State License S S SLC License 2
or o er/builder f,1--eC-70 I
License
LC License al 0
The undersigned does hereby' agree to indemnify and hold harmless St Lucie Countq, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, whilh may arise as a result of this change of
contractor/subcontractor or/cancellation of permit. A permit cannot be cancelled il -Aork has been performed.
SIGNATURE OF OWNER (
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
F
SIGNATURE GENE Oi�(or new GC, as applicable)
PRINTNAME ��%� �` 1 a1
State of Florida, County of St. Lucie County
e following ins m nt was acknowled ed bofie this
t�day of / 20/lbyg (il/
1-i4 Y)l(�o// who i ersonally kno 0
has prod
Signature o§Notar Date Qom
y �e VP N
.0�o�
a
PERMIT #
PLANNING & DEVK
Building & Code
BUILDIN
SUB-CONTRACI
ELECTRIC CONNECTION
(Company Name/Individual Name)
the ELECTRICAL Su
(Type of Trade)
For the project located at MEADOW WOOD- ##277
(Project Street Address or
It is understood that, if there is any change of status
ISSUE DATE
PMENT SERVICES
,mpliance Division
PERMIT
R AGREEMENT
have agreed to be
for GHO HOMES
(Primary Contractor)
Z/ S Zen .P, h e D12.
;ID#)
ing 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 tub -contractor notice. I
CONTRACTOR
NAME
, 07 r— A
OUNTY CERTIFICATION NUMBER
State of Florida, County ofC.l t' T
The foregoing instrument was signed before c this day of
20�, �orbas
who is personally known uced a
I
Revised 11/16/2016
SUB -CONTRACTOR SIGNATURE (Qualifier)
RANDY SJAARDEMA
'RINT NAME
21055
COUNTY CERTIFICATION NUMBER
State of Florida, County of ST L U C I E
The foregoing instrument was signed before me this 3 day of
JANUARY , 201 Q by RANDY SJAARDEMA
i
who is personally known X or has produced a
as identification.
VIP
L STAMP
Signature of Notary Public
to
06pg76
Print Name of Mtary Public
9' e102�
`aY Pie,, SITYAN T BROMELOW
+�/•°",y�'r +. Notary Public • State of Florida
�Ota�i
Commission # GG 263711
?�r tide My Comm. Expires Oct 17, 2022
Banded through National Notary Assn.