HomeMy WebLinkAboutCHANGE OF CONTRACT ORt
From fax5616880909,_1.161.688.0909IFri Jan 11 12:46:21 2019 MST Page 1 of 2
15GANNU)
COU�tV PLANNINC
BUILDING
2300 VIRG]
FORT PIE
(772) 462-1°
& DEVELOPMENT SER
& ZONING DIVISION
.4IA AVE
CE, FL 34982
53 FAX 462-1578
JAN 1 1 2019
Permitting Department
St. Lucie County, FL
PLEASE SELECT ONE. OF THE FOLLOWING:
CHANGE OF CONTRACTOR - Change f Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current perm t. A new permit application must also be completed with new
contractor infonnation and signature. A new Notice € 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 - Subc ntractor changes are to be completed by the general contractor.
The. new.subcontractor must fill out a Subcontractor 1greement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT- The cane l
Cancellation of permit is to be signed and notarized }
cancellation of the permit.
Date: ! //. /q
Site Address: J,Q 2 - -e- ✓ 1
Comet Electric
Original GC', subcontractor or owner/builder
Electric Connection
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold liar
costs, fees or damages arising from any snd all claims of actin
contractor/subcontractor or cancellation of permit. A permit c
SIGNATURE OF OWNER (or owuer/builder)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
dayof —----- 20_. by --
who is persomtlly lutocvn to me
or who has produced as fD.
Signature of Notary Date
Revised 04/15/16
ition of a permit is acceptable only if no work has been drone.
both the owner and qualifier of record. There is no fee for
Permit Number: _ /8 D C, 7 — 0 S
M
State License SLC License 28663
License SLC License 21055
less St Lucie County] its officers, agents and employees from all
for any reason, which may arise as a.result of this change of
snot be cancelled if hvork has been performed.
(or new GC, as applicable)
PRINT
State of Florida, County of St. Lucie County
The following instrument was acknowledged bet'ore me.this
,A_L'doy of ;204, by eV ;�%� i L% ✓�7
who is6ersonallv town to
me or who has ei�"•""~�.�s ID.
of
' pima
0`� �� ', Rebecca Gu�07l;
��C• F a Commiss,Uary 9, 2021
I''' "FOP. nrSea +