HomeMy WebLinkAboutChange of sub-contractorPERMIT# I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERT IFF
SUB -CONTRACTOR AGRi EMENi'
Hypoluxo Plumbing, Inc
have agreed to be
(Company Name.`Individuat Name)
the . Plumbing Sub -contractor for �ilders, Inc.
(Tpe of Trade) (Prirli3ry Contractor)
For the project Located at 30$ .Q1kw'Y% A-/ ��' "i � 2J
(Project Street Address or Properly Tax In 4)
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.
C'O'NTRACT0R 91GN ITR , 1 "nice)
Glenn A Davis 11
CBC 1261228
C IN`17` CF: 11FICATION NUMBER
State of Florida, County of Martin
�j
'11te foregoing instrument was signed before ine this (I. -IV of
A D,-,,i J A
who is personally knowri ✓ or has produced a
as idenftification.
sipnai of Notary Public
Print Nauic of lNotare Public
SUIT -CONTRACTOR SIGNATURE (Quatirkr)
David Price
PRINT NA1IF
30791 St Lucie 06 / CFC1430015 State of FL
COUNTY CEItTIZ' ICATION N UM tSER
Palm Beach
Sore of Florida, County of._
Tit(- foregoing instrument was signed before nic this day of
l' l
Who is Personalty known or has produced a
as ideiitiricati n.
nuSTAMP
Signature of Notary Put)E
Karl J. Hartel
Print Name of Notary Public
o,1 H
, Vsky pile.. RHONDAS ROWS Ra ^ ''' Notary Public State of Florida
r `�" •"" Commission # GG 104656 Karl artel
* Expires May 19, 2021 z'= o� My Commission GG 164385
oq tica Expires 11/3012021
Revkcd 1l%I6!2016 N��rFOFF����O� 8ondedThru8udgelNOtaryServices
PLANNING & DEVELOPMENT SERVICES
ic'`-J,_ '
>3UILDING & ZONING DIVISION
O � 0
2300 VIRGIN [A AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERNTT
pLEASI SELF'CT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarised by the property owner,
and the nett, 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 Cotnnlencetneltt roust be filed itt the new contractor's name
for job vralues greater than $2,500 ($7 500 if AX Change -out). A recorded copy n)ust be submitted prior to
c7C,ANGE
neing any work. There is a $50.00 fee for the Change of Contractor.
OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is at $50.00 fee for the Change of Stab -
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 owtler and qualifier of record. There is no fee for
cancellation of the permit.
Date: al ' °2 ' o-D
Site Address: s a6 P,1 J_YYI B Y,
Permit Number: Z 00-1- 04(v�
Dr
,— f) tFr <:� kJ �=1i..lFi r r' N�C:� 1, �(', � 'C� l,'�ii '
t C'., State License �Lj!C _5 `Tel i.�SLC License . Z21 _ f
a r t
Origi 1 GC, subcontractor or owncdbuild , (z z : iS t i t- \ c- -.
t t. E ` t ` �' t} ); t_ _ r�y-"r C---. State License (•'t t`! i C :f" t :3 SI.0 License 30 `11 `?
New Csubcontractor .+ — _.__---•
Reason for Cancellation 21i ,4
The undersigned does hereby agree to inde minify and hold harmless St Lucie Cotutty, its officers, agents and employees from all
costs, fees or damages arising from any and all claims oraction for any reason; which nrw arise as a result of this change of
'act , lsubcontractor or cancellation of permit. A perniit cannot be cancelled i ' ' rk has been performed.
SIGNATU 01:0�G NGR (or o�\morbuiltfer) SIGRATURtiCC)\1'RAC'1'UR (or new C.C. 15 applicable)
PRINT NAl-' !.%t_ PRINTNA\t1._,DdV] d —Price
State of Florida. County of St. Lucie Cotuity
The following imArti rent wag acknowledged before wo this
.Z cla4 of
�fl ZU [ \_ �i SA- Fuel c�
_... i. .......
. \4'ha is personally kno\\m in Inc
or �ritcr a, produrcd
___�n___8s It7
Signature of Notary
hate
Aooe, RHONDA S ROWE.
otAY
Commission # GG 104666
ANJ9Or Expires May 19,2021
,","off Bonded7hruBudgelNoteryservlces
State of Florida, Count% of St. t.ucie County
The foilouing irutntpun \ra>;rcknowlecl�ed bet'oru nt• (it'J+'',,
Z._day of
_..._._._____ �__ _ ✓ who is personally known to
me nr who
Signature or \otan Dade
�o,pp aty4c Notary Public State of Florida
Karl J Hartel
o My Commission GG 164385
.9-eofF00 Expires 11/30/2021