HomeMy WebLinkAboutChange of sub-contractor, plumbingt
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
g FORT PIERCE, FL 34982
(772) 462-1.553 FAX 462-1578
CI•iANGE 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 ofrecord for the current permit. A new permit application must also be completed with net��
contractor information and signature. A new Notice or ton nlCuCelnent 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
comr ncing 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 most fill out a Subcontractor Agreement Form. There is a S50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERN11T —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: t ��
Site Address:
Permit Number:
-1 Pm-CIL-
c: xd F1Z..tt'irr' K-'c'N ��. •. - l.:ii :i'k
t L hn t t` State License �-e..Cif} q SLC License,—,�/:Z
Origi t GC, subcontractor or owner/b wild
kA 1.A 1 V -X. C."' P is a�Y-,\ C'._ State License *r2'!'(SC CA f3 SIX License
New C3 ', subcontractor
Reason for Cancellation Z A
Y
The undersigned does hereby agree la indunnlify anti hold harmless St Lucie County, its officers, agents and employees fromall
costs, fees or damages arising from any and all claims of action for any reason; wlfich may arise as a result of this change of
•act 'subcontractor or cancellation of permit. it permit cannot be cancelled i)" ''ark has been performed.
SISIGNATURE (YE rGtCCNRam_ or new (iC, as applirrhle)
PRT1 T Nt l-I., _Ya'1_�j�,� PRINTNAW David Price
Stare of Florida, County of St. Lucie County
The following instnnncnt was acknowledged hcloT. C we this
day nt: ?o?�-? try �--I SA- Fi'e— l
-
-..__.._....... __..___._._:....._......_.___
_' __.. Wl10 is personally halown to me
or Ao ha, produced._-
_ ?rs I[)
Signature of Notary
Date
re._sed i'�ri9r,o
ZW PCB RHONDAS ROWE.
Commission # GG 104656
*
oe Expires May 19, 2021
NaglscppO
Bonded ThruBudget Notary services
Slat-, of Florida, County of St. Lucie Count;
The followtrig itI ntment w'a acknowledged bet'ore,nt1cltill
21�• by__�Lu-tomC1/
__—who is personalty known to
me or w•ho as produecd__--- as [1).
.—
Signxturc of \otunI)afc
�apv Pti#, Notary Public State of Florida
Karl J Hertel
• o My Commission GG 164385
1)1o, Expires 11/3012021
PERMIT #
18SUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BU11:D1NG PERINUT
SUB -CONTRACTOR AGRtEJAENT
Hypo}uxo Plumbing, Inc — have agreed to be
(Company Name'Individual Name)^ anon
the, Plumbing _ Sub -contractor for Builders, Inc.
(Type of Trade) (Primary Contractor)
1
For the project toeated at'1 155. ajm rAd z o D�-
(Projeci Sirect Address or Properly Tax ID
It is understood that, if there is any change of status regarding, our participation with the above mentioned
project, the Building and Corte Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor Notice.
=!J�� - &, &- "'� 7-5E,�-
CO'NTRAC:TOR SIG ATC R > Iualitier)
Glenn A Davis 11
PRINT NNANIE
CBC 1261228
COUN'I`S` CERTIFICATION NUMBER
5tateufFloritia,Cou�it of Martin
77te foregoing instrument was signed before me this i � • day of
tg / �_ _
—1 ' D s
wlio is personally knoivii or has produced a ,^
as iden[ti^fication. A—k--1b-VL.,1--
"-Y� -
Signaiu • of Notary Public
Print Naiiic of Notary Public
StIR-CONTRACTOR SIGNATURE (f2ualmer)
David Price
PRINT 1 UMF _
30791 St Lucie Co / CFC1430015 State of FL
C{7LSN'fl`C'ER7'If'IC_1'i'IO� tiCfIfiE12
Palm [leach
State of Florida, C 'Hilts o1' -
'fate foregoing instrument was signed before ore this day (it'
{' .• 21) : by
who is personalty known or has produced a
us idcittitictti u.
i
r f
STAMP t
7-
Signature of Notary Publi
Karl J. Hartel
Print Natue of Notary Public
° Notary Public State of Florida
Karl J Ii'artel
c� My Commission GG 166,4385
Revised 11; 10120 16 BondedThruBudgelNoteryServlces 4os �Qe` Expires 11/30/2021
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°
RHONDAS ROWE*a
20 `' *
Commisslon#GG104656
*
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Expires May 19, 2021