HomeMy WebLinkAboutCHANGE OF CONTRACTOR. �ir/ANN RECEIVED
By JAN 0 71019
PLANNIl' �rbPMENT SERVICES �'errr fitting Department
¢ _ i St. Lucie Coun
- BUILDING & ZONING DIVISION �'
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 1 FAX 462-1578
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 job al es greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
con cing 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: Permit Number:
/8d� _ 0/ 7
I
Site Address: ) ,h
K#---j )4� A,,6a ) Ca State Licensee -rA y S SLC License
riginal GC, subcontr for or 4" & e / (f /ih (f State License SLC License
ew GC, subcontractor I
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 ay arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if ork has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE G TO jR (or new GC, as applicable) /
PRINT NAME PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_ by
is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
State of Florida, County of St. Lucie County
The fo�cving i t was acknowledged b f rye m this
—day of�' 20 by 6l
�(� �►�/ is personally kno to
of
�� Re�� GG�pgZ6
;� �-s �p1� gamN �yotarl
PERMIT# Zap ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
I
i
ELECTRIC CONNECTION
(Company Name/Individual Name)
the ELECTRICAL
(Type of Trade)
Sub -contractor for GHO HOMES
(Primary Contractor)
For the project located at MEADOW WOOD- #egg
(Project Street Address or
i
)erty Tax ID
have agreed to be
(/ J
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.
i
i
CONTRACTO G UR ual ,er) CONTRACTOR SIGNATURE (Qualifier)
rd v'.- /,r) d l a m RANDY SJAARDEMA
PRINT NAME PRINT NAME
21055
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida, County of e— State of Florida, County of ST L U C I E
The foregoing instrument was signed before me this-7 day of The foregoing instrument was signed before me this 3 day of
G(�
2P JANUARY , 201 Q by RANDY SJAARDEMA
+ 0�, by i
who is personally known r has produced a who is personally known X or has produced a
AMP
�p�ma 16
021
ExP`ces•�Notary
e;agd�,`„
Revised 11/16/2016
as identification.
3r_2�_� STAMP
Signature of Notary Public
i
Print Name o otary Public
sHYAN T BROMELOW
Notary Public - State of Florida
Commission # GG 263711
'FoF My Comm. Expires Oct 17, 2022
Bonded through National Notary Assn.