HomeMy WebLinkAboutChange of sub contractor form and sub agreement I
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 PERMIT
I
PLEASE SELECT ONE OF THE FOLLOWING: Change of Roofing Contractor only
x 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.
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: July 7, 2020 Permit Number: 1911-0324
Site Address: 7703 Palomar Street, Fort Pierce, FL
Owner/Tom Hunter State License SLC License
Original GC,subcontractor or owner/builder
The Roof Authority, Inc. State License CC C056933 SLC License
New GC,subcontractor
Reason for Cancellation
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,whic ay rise as a result of this change of
contractor/subcont ctor or cancellation of permit.A permit cannot be cancelle r as been performed.
SIC-NATURE OF OWNER(or owner/builder) SIGNATURENERAL C NTRACTOR(or new GC,as applicable)
PRINT NAME Thomas Hunter PRINT NAME Istopher A. Long
State of Florida,County of St.Lucie County State of Florida,County of St,Lucie County
The following instrument was acknowledged before me this Th�t lowing ins�al7rit was ack�vledged before me this
7th day of JUIy 20 20 by day of y 20_,by
—Tomas un er Christopher A. Long
wlio is personally known tome who is personally known to
or who has produced as ID. me or who has produced as ID.
July 7, 2020 l�,J July 7, 2020
Signature of No ary Date Signature CrNotary Date
Timothy W.Sutton
Revised 0 5/i6rimothyW•Sutton $S/,VCr-9
NOTARY
PUBI-IC
NOTARY PUBLIC oSTATE OF FLORIDA
STATE OF FLORIDA Y Comm#GG185982
Comm#GG185982 Expires 312012022
'S/Hc g1� Expires 312012022
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PERMIT# i 191 -0324 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
COUNTY
_-------- __.. __-. BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
The Roof Authority, Inc.
have agreed to be
(Company Name/Individual Name)
the Roofing Contractor Sub-contractor for Tom Hunter
(Type of Trade) (Primary Contractor)
For the project located at 7703 Palomar Street, Fort Pierce, FL 34951
(Project Street Address or Property Tax ID#)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project,the Building and Code Regulation Division of St.Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
CONTRACTOR SIGNATURE(Qualifier) SUB-COTRAC OR SIGNATURE(Qualifier)
Thomas Hunter Cher A. Long
PRINT NAME PRINT NAME
CC C056933
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of- St. Lucie State of Florida,County of St. Lucie
The foregoing instrument was signed before me this 7th day of The foregoing instrument was signed before me this 7th day of
Jul 202 b Thomas Hunter July 20 Christopher A. Long
July Q y r 20—,by
who Is personally known_or has produced a who is personally known X or has produced a
as identification. t y� as identification,
�t/ry1U'I�LN�1►�Iy- STAMP 7—yi, S v;t t,- STAMP_
Signature of Notnift Public Signature of Nopiry Public !
Timothy W. Sutton Timothy W. Sutton
Print Name.of Notary Public Print Name of Notary Public
Timothy W.Sutton Timothy W•Sutton
IOU-
ZRRYAS ` ��+ NOTARY PUBLIC
NOTARY PUBLIC-STATE OF FLORIDA �� a 1�STATE OF FLORIDA
�� Comm#GG185982Comm#GG185982
ReviseExpires 3/20/2022 1� Expires 3/20/2022