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Home My WebLink AboutCHANGE OF CONTRACTORM- r PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE SCANNED FORT PIERCE, FL 34982 BY (772) 462-1553 FAX 462-1578 SL Lucie County 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. °'fig' 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: 8/19/19 Site Address: 6701 S. US Highway 1, Port St. Lucie, FL 34952 Concurrent Group, LLC / Fernando Manuel Munilla Original GC, subcontractor or owner/builder Goff Communications, Inc / Douglas L. Smith New GC, subcontractor Permit Number: (Sprint Site ID: MI90XSRRV) 1810-0133 License EC13008099 SLC License License EC13004137 SLC License Reason for Cancellation Original subcontractor declined the work The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all 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 s been performed. SIGNATURE OF OWNER (or ovm'er76u erdN-r ) - ISIMAWRE GAR ai. ON CTOR (or new GC, as applicable) PRINT NAME Michael Burkhead PRINT NAME Stephen Saylor State of Florida, Coonty of St. Lucie County State of Florida, County of 25t_�nMy e following i tnunewas acknowledged before me this The following instrument was acknowledged before me this day of_� 20 79 byi� e ', V' I-�Jq day off,t20'� by Michael Burkhea who is personally known to me �l•/7 S eph(o Saylor who is personally known to or who bas produced ,�). Y,)� . as ID. me or who has produced V as ID.' ,///J� f�j 8119/19 ��,z 8/19/19 ��• p,VID ApA 1.i Ig "reo Date Signature ofN ry Date �rP O•••N� •••'`�(rl �� 1 1 t Puat�inc a Rsc nsaato, : m Revised 04/ 5/1 n ' MY COA/MlgalpN -' i:_'••. AUDREY B. HUMPHREY �?��•.tort•_� 'sA MYCOMMISSION UGG30081T ♦ :h,••'••�.:-•'•• �Q�� a-,• po EXPIRES: March 6, 2023 ♦♦♦i�ryljf� LTH OF;, �' Bonded That Notary Pubuctindewdlers IIIHIIt K PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 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 Sled 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. 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 PERAHT — 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: 2/5/19 Permit Number: 1810.0133 Site Address: 6701 S. US Highway 1, Pon St. Lucia, FL 34952 (Sprint Site ID: MI90XSRRV) Charlie Craig and Associates, LLC State License CGC1521912 SLC License Original GC, subcontractor or owner/builder BlueStream Professional Services, LLC State License CGC1526974 SLC License New GC, subcontractor Reason for Cancellation Original contractor declined the work. The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all 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/subc tractor or cancellati I ofperan . A permit cannot .be //ne�ealled 1f work has an pe ormed. SIGNATURE OF OWNER (or owner/builder) SIGNA=RE GENERAL (or new GC, as applicable) PRINT NAME Michael Bulkhead PRINTN,AME Stephen Saylor state of Florida, County of St. Lucie County The following instrument was acknowledged before me this —r—dayof February .20 t9 ,by Michael Burkhead who is personally known to me s rodVced �ID/9Choha ature of Nofmy Date VgTPfy� Notary Public Stets of Florida Revised 04/15/ 6a4 `(. Hslelgh Wmor �y,�S6jh My commission GG 107396 '•orn fires 06127/2021 State ofFlorida, County ofSL Lucie County The filllowing instrument was ack rimledged before me this �' myof_ roeN.y .20—" by Stephen Saylor who is personally known to meorwhohasptaduce azID. 2f5l RJ p Siguaddeof Notary Dale ANGELA D. CERBANA ' NoteryPublo-Mhmasota `� My CommismottBpktv9113fI20.12