HomeMy WebLinkAboutCHANGE OF SUB-CONTRACTORRECEIVED
PLANNING & DEVELOPMENT SERVICES BAN 0 7 2019
BUILDING & ZONING DIVISION Pormitting De
2300 VIRGINIA AVE St' Lucie county
FORT PIERCE FL 34982
(772) 462-1553 FAX 462-1578 QCANKO
BY
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
11 CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and he new contractor of record for the current permit. A new permit application must also be completed with new
conil actor information and signature. A new Notice of Commencement must be filed in the new contractor's name
forob clues 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.
` 11 CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The bew 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.
ation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
ation of the permit.
I
Date
Site �ddress:
Permit Number: 4 9d,9— 0 /,36
A
0 tt7 W `Pa / L 0 /P Cc �r State
GC, su�or or own r/builder 0 4L
subcontractor
for Cancellation
License 2,
License SLC License 6 ,�_S
The dersigned does hereby agree to indemnify and hold harmless St Lucie County its officers, agents and employees from all
costs, ees or damages arising from any and all claims of action for any reason, whit may arise as a result of this change of
contr ctor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER
NAME
State f Florida, County of St. Lucie County
The fo owing instrument was acknowledged before me this
day of 20_ by
who is personally known to me
or whol I6s produced as ID.
of Notary
Revised 04/15/16
Date
IGNATURF�iE 0rAL — vC TOR (or new GC, as applicable)
PRINT NAME Iill Il% 11M 4 4 f ,Pr
State of Florida, County of St. Lucie County
The f llowing instrument was ackqowledged bef e @ this
day off, 20, by (,�j i a jn
who is ersonally kno to
e or has roduced as ID.
Com �Dima
GG061111
Expires: Janaa10, fotary
and thrU Aaron
i
�1 ISSUE DATE
,','ERMIT # 1
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
LECTRIC CONNECTION
Iil(Company Name/Individual Name)
the E CTRICAL
For
It is
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for GHO HOMES
pe of Trade) (Primary Contractor)
ject located at MEADOW WOOD- ##278
(Project Street Address or Property Tax ID #)
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
i
filing a Chan&e of Sub -contractor notice.
CONTRA=ORS TU (Qualifier)
'1 a
INT N' E
i
S -C S s
COUNT CERTIFICATION NUMBER
State OfF orida, County of
The foreg ing instrument was signed before me this / day of
2411 by
who is pe Sonally know or has produced a
1.
en 0�1
STAMP
Si natur ',b otary Publi ID\m _ e16
Print Nar a of Notary Public `$? '',�eS• ,�u�(on��
Revised I
SUB -CONTRACTOR SIGNATURE (Qualifier)
RANDY SJAARDEMA
PRINT NAME
21055
COUNTY CERTIFICATION NUMBER
State of Florida, County of ST LU CI E
The foregoing instrument was signed before me this 3 day of
JANUARY , 201 `� by RANDY SJAARDEMA
who is personally known X or has produced a
as identification. l
11 STAMP
Signature of Notary ublic
Print Name of Ndtary Public
o��Y P,&' SITYAN T BROMELOW
r h� Notary Public - State of Florida
Commission X GG 263711
My Comm. Expires Oct 17, 2022
Bonded through National Notary Assn.