HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 SCANNED
(772) 462-1553 FAX 462-1578 BY
St. Lucie County
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
(;r;' .. CHANGE OF CONTRACTOR— Change of Contractor is to be signed and notarized by the property owner,
=apd the new contractor of record for the current permit. A new permit application must also be completed with new
f cbritractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
t ,,commencing any work. There is a $50.00 fee for the Change of Contractor.
X 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.
i
Date: �� 2!/ Permit Number: % —n (� '
$ite Address: ✓ G y/) ��/ tl ,✓ (1Ji2 .
:Electric Connection / Randy Sjaardema State License SLC License
Original GC, subcontractor or owner/builder
AC Quality Electric
New GC, subcontractor
License EC13004128 SLC
Reason for Cancellation Original Contractor can no longer do job as needed
The undersigned does hereby agree to indemnify and hold harmless St Lucie Cour
costs, fees or damages arising from any aud'all claims of action for any reason, wh
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled
SIGNATURE OF OWNER (or owneribuilder) SIGNATURE R,
PRINT
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of . 20_, by
personally known to me
.,or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
William
21055
ficers, agents and emp
arise as a result of this
has been performed.
;TOR (or new GC, as applic
GRBK GHO Homes LLC
State of Florida, County of St. Lucie County
11e gi owing instrument was acknowledged before me this
3day of, 20-Ll, by
-
who ' '�"" who is personally know., to
me or who as produced. �. as ID.
,,""" Rebecca "'�p60BT6
,; Pry Pl!ej�o (nlss�on � � 4021
Will Y 9,
;,a��a Bonded�N
of
M