HomeMy WebLinkAboutCHANGE OF SUBCONTRACTOR=9
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
SCANNED
BY
St. Lucie County
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF TIME 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
i•>
;; coactor information and signature. A new Notice of Commencement must be filed in the new contractor's name
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for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
V commencing any work. There is a $50.00 fee for the Change of Contractor.
Xxx 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: a
;} Site Address: _
Electric Connection
I Original GC, subcontractor or owner/builder
Permit Number:
License SLC License 21055
AC Quality Electric State License EC13004128 SLC License
New GC, subcontractor
Reason for Cancellation Changing Sub Contractor to Complete
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, it 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 w rk has been performed.
„ SIGNATURE OF OWNER (or owner/builder)
.r
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day of ,20J by
who is personally known to me
or who has produced as D.
'-Signature of Notary Date
,,. Revised 04/15/16
SIGNATURE
PRINT
/ GRBK GHO Homes
State of Florida, County of St. Lucie County
The fo lowing instti;Lmentwas ackno ledged before me this
ayof f u,(y_, 27by
William Handler ✓✓ who is personally known to
me who h produced " "—_—" as ID. ,
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,,,, � Rebecca Dim�,�'�.fl/���F= Commission#GG060676
�r. *- Expires: January O'Notary
Bonded thin Aaron
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