HomeMy WebLinkAboutCHANGE OF CONTRACTOR—� SCANNED RECEIVED
BY
PLAN00—.NDEVELOPMENT SERVICES JAN ®' 2019
r r Pe p
BUILDING & ZONING DIVISION St. Lucie �ountv
eenr
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
the new contractor of record for the current permit. A new permit application must also be completed with new
tractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
Ijob values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
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.
new subcontractor must fill out a Subcontractor 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:
Permit Number: [ 8 0— 01 1
Site Address: ezr,,41--p
d State License
Original GC, su contractor or ow er/builder
Gi._ State License
New 6C, subcontractor
Reason for Cancellation
VAM
License 2. q (.,'-.j
License b IS
The undersigned does hereby agree to indemnify and hold harmless St Lucie CLif
officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason,ay arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelrk has 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 CEJC
R9ACTOR (or new GC, as applicable)
PRINTNAME�W`I�)
I k w Glydtt,
State of Florida, County of St.
Lucie County
The f ]lowin instru ent was ackno ed ed before methis
ss g g
_�P�ay of 20 by o
V
0
who is rsonally k to
me or wh as roduced
as ID. ,
RMIT # I ' A v f 01 1 l I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
ELECTRIC CONNECTION have agreed to be
(Company Name/Individual Name)
the LECTRICAL Sub -contractor for GHO HOMES
I(Type of Trade) (Primary Contractor)
For t e project located at MEADOW WOOD- #56 106y �G� 6)je
(Project Street Address or Property Tax ID #)
It is ` nderstood that, if there is any change of status regarding our participation with the above mentioned
proj ct, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filin' of a C ange of Sub -contractor notice.
CON G E (Qualifier) SUB-C TRACTOR SIGNATURE (Qualifier)
cQ ) cQ )
II ad 4 J%i RANDY SJAARDEMA
PRI NA PRINT NAME
S' S 21055
CO Y CERTIFICATION NNUMBElR, , COUNTY CERTIFICATION NUMBER
Stat' of Florida, County ofy l/Vl G1 State of Florida, County of ST LUCI E
The! oregoing instrument was signed before me this y of The foregoing instrument was signed before me this 3 day of
t! ,20-6,by [A) 1 Gil f��yid/rr JANUARY ,201 by RANDY SJAARDEMA
wh is personally known _or has produced a who is personally known X or has produced a I
asp i i Ica 1 as identification.
I"Sk 3
I ST STAMP
Si ature of otary Public Signature of Notary Public
Pr Int Name of Notary Public �ma Print Name of NLo ary Public
.�,V Rebecca D
T% COmmiss,�u ry 9 Q SITYAN T BROMELOW
?I'_ Expires; A� IdotaN
�� ��`• Notary Public •State of Florida
Via; Bonded =_ : -
Q ``�� ;� o Commission ti GG 263711
', o°•' M Comm. Expires Oct 17, 202Z f
vised 11/16/2016 °F,F`B y Assn.
Bonded through National Notary �
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