HomeMy WebLinkAboutCHANGE OF SUBCONTRACTOR - PAYMENT OF FEEPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE SCANNED
FORT PIERCE, FL 34982 BY
(772) 462-1553 FAX 462-1578 StlucieCou $V
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 values greater than $2,500 ($7,500 if A/C. Change -out). A recorded copy must be submitted prior to
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.
Date: 1_ I_�1 2-0 20 Permit Number: I (Q I - 01 U
Site Address:
'2 I I� ��
t,eC_+ � C- CO yu GAc�(pr\ State License SLC License D O SS
Original GC, subcontractor or owner/builder
AC (J ac,J1A:!sA 0,PC riL State License SLCLicense-G 13C0L1128
New GC, subcontractor ` ;2 Q (pa fo
Reason for Cancellation hCs I e�elir U YYY_]Y)VA 3F11r C—W riY_i6 i• A1P)hA I Q U
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fror
costs, fees or damages azising from any and all claims of action for any reason, w rich may arise as a result of this change of
contractor subcontractor or cancellation of permit. A permit cannot be cancel] if k has been performed.
SIGNOZ"WNER r owner/builder) SIGNA ENERAL CONTRACTOR (or new GC, as applicable)
A
PRI NAME L`/ PR r vtr
State of Florida, Co ty of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
yi1L�'���tlnna;of..�I U(o 2V by-k JI�Il
.S1 AW JfC l who is personal] wn to me
ar rho has produced as ID.
Signature of Notary U Date
The following' snument was acknowledged before ttds
�dayof �(`�.0 u by 1 l
UXAY IU 1 L r who is aerswmUy mown to
me or who has produced as ID.
�Y havzc>
Signature of Notary Date
Revised 04/15/16 AWw C, Kel y
COMMIG6249f0
EOfter 22 202:-
Bonded Thm Aamn Nokia •
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9StLucieiSd7l. Lucie County GRLi.--i'10 Homes, L.L.C.
2300 Virginia Avenur 09002
Fort Pierce, FL 34982 09.02-00011549
Jan 9, 2020 $50.00
Seacoast National Bank
Date Invoice Reference Payment Amt Retention
---------------------------------------------------------------------------------------------
09002 GRBK GHO Homes, L.L.C.
01/08/20 MW-260 Sub Change MW-260 Sub Change 50.00 0.00
---------------- -------------
Total Remittance 50.00 0.00
Discount Total Payment
0.00 50.00
---- ----------------
.00 50.00
9StLuciel
.... ....... .
St. Lucie County
_:.. _:. _. _. ._ .. _. ... .. .....
GRBK GHO Homes, L.L.C.
2300 Virginia Avenur
Check
Number 09.02-00011549
Fort Pierce, FL 34982
Check
Date Jan 9, 2020
Date
----------
Invoice Reference
------------------------------------------------------
Payment Amt
Retention Discount Total Payment
09002 GRBK
GHO Homes, L.L.C.
-----------------------------
------------- ----------------
01/08/20
MW-260 Sub Change MW-260 Sub Change
- - 50.00
0.00 0.00 50.00
Total Remittance
---------------- -------------
50.00
------------- --- ------------
0.00 .00 50.00