HomeMy WebLinkAboutCHANGE OF SUBCONTRACTORPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION It il �z D
2300 VIRGINIA AVE
MAR 2 9 2017
FORT PIERCE, FL 34982 §ANNED l3ER11,lTTllqG
(772) 462-1553 FAX 462-1 BY St. Lucie county, FL
St. Lucie Countv
CHANGE OF CONTRACTOR, SIJBCONTRACTOR 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.
XX — 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 no.tarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: March 28, 2017
Site Address: 3200 N. Al A Ft. Pierce, FL 34949
Permit Number: _M770"033 Mow
MCCORD ELECTRIC LLC State License EC13003132 SLC License
Original GC, subcontractor or owneribuilder
GERELCO ELECTRICAL CONTRACTORS StateLicense EC13003415 SLCLicense 2928
New GC, subcontractor
Reason for Cancellation Original subcontractor abandoned the project
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fro-V
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled if work has b nperf
.... u' "u neeneo " woru h b on per'
SIGNATURE OF OWNER (or crwricribuilder) SIG ENE I RACTOR(ornewGcasapplicable)
PRINT NAME I .. iegel
State of Florida, County of St. Lucie County
The fOROWing instrument was acknowledged before me this
ay of 20� by_
0 is Personally known to me
or who has produccd�_. 11).
Signature of Notary Date
Revised 04/15/16
State of Flari&6 County of St Lucie County
XTh III an ment % as acknow edged bar,, me this
MY-9f, Or , �q,'by_
Signature of Not#.r;.--*,
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