HomeMy WebLinkAboutChange of sub-contractor, plumbing- PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CI•iANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERI<TI'
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarised by the property owner.
and the nets contractor ofrecord 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 u) the new contractor's name
,fyr job values greater than $2,500 ($7;500 if A/C Change=out). A recorded copy must be submitted prior to
com/a� nemg any t;-ork. There is a $50.00 fee for the Change of Contractor.
' CHANCE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor mast fill out a Subcontractor Agreement Form. There is a S50.00 fee for the Change of Snb-
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 otvtter and qualifier of record. There is no tee for
cancellation of the permit.
Date: Permit Number: 7-» L)a-gU
Site Address: � � � Ur ✓7L 1I,,, � f
f <':titi1;-tt_!k"{.�.,.. F--x.�y�1 �.-' 1 , -t .��c�...i�t.,�""'
f t a r t' Slate Licensc�F�'CIS 1�1 LC License ,�/:� 7
+ d
6rigiiiAl GC, subcontractor or owneribuild, � :i (:\t 1 Cz p
i -clict,(t-.1 C:.w State License- ' { ! ({ t 5 SIX License J 0'7 ct7
1N`e-,v G ', SubContrtctor - -- -._---
Reason for Cancellation 6)u,,
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 inay arise as a readt of this change of
•act , 'sulic�+titractor or cattcellatian of permii. i� permit cannot �e cancelled i ' ` u9: has been performed.
SIC, NATUR OF 0W,7 :R f ilwAnecbutlder) S[(iNA'rU[tfi GtiT` CC)ti rRAC7`Ult (or new C;C, as applicably
P12TH7 `�F1t'�' L-JLA M�-�1-_ PRINT NAME._.---id_.._Price — — —
State of Floridaw County of St. Lucie County
The following instjUlnent was alela101Ylddt ed beliore we this
SKI !y ot:_ 20&t i by 1-1 5A- Fi'eI of
z...... ..._ .___._. _ . �zho is personally known to mo
or wh ta; produced.._ _{ was [D.
Signature of Notary Date
tt,PY PUBc RHONDA S ROWE
e
u90��+���` 0 Cominisslon # GG 1046A56
Expires May 19,'202l
TF"0.c� BondedThruBudgetNotaryServices
State of Florida, Count% of Si. i_ucie County
The rolbwing it tmme a u:n+ acknonledzecHictbre me th j J
UU14.11CJL-
y"' —oho is personally known to
me or echo as produced as
Signature of \otan• Date
�oPY Pue Notary Public State of Florida
Kari J Hartei
N a My Commission GG 164385
�JP Expires 11/3012021
PERMIT ## ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PEWNIFF
SUB-C'ONIRACTOR AMEEM ENT
Hypaluxo Plumbing, Inc_ _ haveagreed to he
(t;otnpanyN, me.11ndividua(Natne)�---- IZe,r,Qi
the. Plumbing _ _ _ Sub -contractor for R guilders, Inc.
(TyI)e of Trade) _ (Primary Coiitractor)
For the project located at() 7a5—
(Pritjeci Street Address or Property fax ID �)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Buil.ding and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor Notice.
C.ONMRAC:TORSIGNA,ITIR-. haliifier)
Glenn A Davis 11
PRINT N:\NIE
CBC 1261228
CO NIN CER'11114CATION NUNl3EII
State or Florida, Count} pf Martin
_
i
I7u fnrewimg histrumenl was si�nccl before nie this { �/: • tla) of
A Der s
Y E
who is personally knosyn✓ or has produced n
as identification.
Signain of Nnlary Public
Print\Mille ot'Noture Public
SUB -CONTRACTOR SIGNATURE (Qualifier)
David Price
PRINT N-AM : —
3W91 St Lucie Go / CFC1430015 State of FL
COUNTY CERTIFICATION NUNMUER
State of Pldridsy County of Palm Beach_
The foregoing instrument was signed before nre this _°"� da) fir
who is personally known _or has produced a
as ideiiNlie;ili n.
STA IP
Signature of Notary Piibli
Karl J. Hartel
Print Name of -Notary Public
y�Y PUg RHONDA S ROWE ° '"` Notary Public State of Florida
ro `.•..,`��� Commission#GG104656 Karl J Hertel
* c" My Commission GG 1n'4355
Expires May 19, 2021�o ea Expires 11/3012021
Revised 11;16!2016 NT9rFpFF`pQ�r Bonded7hruBudgetNotaryServlces