HomeMy WebLinkAboutChange of sub-contractor, plumbingPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
d 2304 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERNIT
BLEASI SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR —Chancre of Contractor is to be signed and notarised by the property owner.
and the nevv contractor of record for the current permit. A new permit application must also be completed with net>,
contractor information and signature. A new Notice of Commencement trust be filed in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Changc-out). A recorded copy must be submitted prior to
coma neing any work. There is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by tite general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is at S50.00 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: _ G , "A , af) Permit lumber: — � U b to - d
Site Address: 3.41�_ j� Im_ jy p� T) ,, t t� �� ,7
l t_..t_ ' o A (' State License �f' ' `� 7�1 % SLC: License _. %_:2._ l
6righliAl GC, subcontractor or owner/buildeld t)t ;
i Y) , l t��N C__ State License �' ( 1C i `3 SIX License \ 1� J' j `7 {
New G(','subcontractor —
Reason for Cancellation i—��i r� ✓1 cY (�y'ry
The undersigned does hereby agree to indemnify and hold harinless St I..ucie Cotinty. its officers, agents and employe" from all
costs, fees or dainages arising from any and all claims of tuition for any reason, which may arise m a result of this change of
act /subcontractor or cancellation of permit. A permit cannot be cancelled i -k has been performed.
$IC.iNATL?Rh t1F O�VNti:R (or o�vnr r:buililer) S[Ci\n'RJI:I CiET\ . . CO:\1'RAC'Tl>li (or new (iC, as applicable)
PRIM ?�At= ' �,{_ ry r PRINT N'AMI: David Price
1 t.t I�
State of Plonda. County of St. Lucie County
The following utsirtnnent was acknovdedg4d &lore we this
-.._ _........V ... _..... .. _ ....... _Who is petsonally known to me
X1, produced :is ID.
Signature of Notary Date
F:�:st. CrrSi_;
o01tyPik RHONDA$ROWE.
` Commission # GG 104656
'f'a9r - oe Expires May 19,2021
TOFF °Q Bonded 7hruBudget Notary SeNlceg
State of Florida, Count% ol'St htcie County
The following itutnunent as rckruryled-ed betbre me Il
F'Y
by �_. )c.l
who is ircNonally kncnm to
me nr rho as produced a1s 11).
Signature of,.otary Dale
�o0%v rro,r Notary Public State of Florida
Karl J Hertel
N a My Commission GG 1643a5
9irOffloo-`° Expires 1113012021 f
r
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building, & Code Compliance Division
Hypoluxo Plumbing, Inc
the
. (Tyl)r- of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for 49� ruilders, Inc.
(Primary Contractor)
For the j)roject located at AITA 9Yj47d.<, 1)e
(PrOjeciStrect Address or Properly Tax ID 4)
It is understo,od 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 SIGNATURF,Iualifiee)
Glenn A Davis 11
CBC 1261228
COUNTY UIVITFICATICiN NUMBER
State ofFloriiia.County of Martin
Ilie foregohng, instrument was signed] before ine this < day of
A NT. T
L
who is pierson-illy kuoivn✓ or has produced a______
as idelitification. I
I . ,
R. iatiiof Notary Public
Print NanI6 of'Notal'y Public
C/
SUB -CONTRACTOR SIGNATURE (Qualirkr)
David Price
PRINT MAW
30791 St Lucie Co / CFC143001 6 State of FL
cou.N,rYCERPIVICATION NUNIBER
State of Fldri(h. Counky of Palm Beach
The foregoing instrument was signed before me this day of
21) by
who is personalty known or has produced a
as idchtificati a.
STAMP STANIP
Signature of Notary Publi -7
Karl J. Hartel
Print Name of Notary Public
• Vskv+FUFIiRHONDAS ROWS
4P Notary Public State of Florida
Commission # (3G10465516 Karl J l4airtel
Expires May 19, 2021 My Commission GG 164385
EXPIhis 1113012021
Revised 11; 10!2016 Bonded Thru Budget NotarY $6N105