HomeMy WebLinkAboutChange of sub-contractor, plumbingPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CIiANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELEf_'T ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR - Change of Contractor is to be signed and notarised by the property owner,
and the new contractor ofrecord for the current permit. A new permit application must also be completed with new•
contractor information and signature. A new Notice of Conimehcement must 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 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 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: l ' � Permit lumber: o2-60
Site Address 5. I --_--,- X;W
A V\ T
State icense� 7q 7 . SLC License
Origi l GC, subcontractor or owner/build- k, Ci t." it-,
S j { i ->'
Y"'t C- State License t P. t t' t' l SLC License try 1
New G ', subcontractor
Reason for Cancellation1 Cj}
The undersigned does hereby agree to indemnify and hold harmless St t.ucie Cotutty, its officers, agents and employees from all
costs, Pecs or damages arising from any and all claims of action for any reason; which may arise as a result of this change of
act .:'subcontractor or cancellation oaf permit. A permit cannot Lie cancelled E' ' rk has been performed.
V '
S1GNTATURt OF (OWNER (or otvner-butlder) S](lNn'RIRI CsEh CC)N'1"RACT't )tt (or new C;C, as applirablc)
"r.'? T?l` NAP- ,Z�_ D PRINT NA',•tt: .David Price
State of Florida.. County of St. Lurie County
The following iusirtin unit was acknowledged beibre we this
.= __day of
_...... ...............__.-------- ` _._..__.._wha is p,asonally known to me
or � 1 o ha lrroduccd , :is II)
Signature of Notary pate
rot�av aue�� RHONDA S ROWE.
* * Commission # GG 104666
N o Expires May 19,'2021
011;" Lo�� Bonded ThruBudget Notary Serviaes
State of Florida, County of St. Lucie (-ounty
The following i"Pit"enet l was acki2 vledgcdi I titre me ti
ay of
who is personally kno?nt to
me or who +s pt. duced_ as flf).
Signature of \utanllxic
ps�r Py#, Notary Public State of Florida
Karl J Hertel
a My Commission GG 164385
'�� Expires 1113012021
FERM1T # ISSUE DATE
PLANKING & DEVELOPMENT SERVICES
Building & Code Compliance Di -vision
BUILDING t'ERNIFF
SUB -CONTRACTOR AGREEtM EINT
Hypaluxo Plumbing, Inc have agreed to he
(Company Name%Individual Name)
the. Plumbing Sub -contractor for R-rw Builders, Inc.
(TYpe of Trade) ^^ ^ (Primary Contractor)
s�
For the project located at i5��ir
(Pritjcel Strcet A tdr ss o Property Tax ID
It is understood that, if there. is any clfange of stattis reggarding our participation with the above mentioned
project, the Building and Code .Regulation Division of St. Lucie County will be advisees pursuant to the
filing of a Change of Sub -contractor noltice.
CONTRACTOR SIGNATUR : Iuafitier)
Glenn A Davis 11
PRINT NANfE _
CBC 1261228
COVNIN CF.fii'IFICATION NUMBER
State or Florida, County of Martin
'171e foregoing instrument was signed before ine tithis clay' of by Qle.nn . A Di+ i s 16
who is personally knownor has. produced a
as iden
tification. ,
J-4rl
Slgnaiu of Notary Public
Print Natitc ol'Notari Public
Sufi -CONTRACTOR SiGNATURE (Qualified
David Price
PRINT N-AAME:
30791 St Lucie Co / CFC1QG015 State of FL
cot.,N'rl' C'£ICI'li<'ICATION NUNIBER
Pai-n Beach
State of Plnrid:y County of -
'rite foregoing instrument was signed before nu this _:__ day or
r-
who is personally known or has produced a �.,__----
as ideittitica(i it. s
f ' 8
STAMP _ _ _— _TJ SiA
Signature of Notary Puhti '
Karl J. Hartel
Print Name of Notary Public
mVf PIIg RNONDA3 ROWS �� ° Notary Public State of Florida
r° .••"•.�'� 4 Karl J Hartel
* Commission # GG 104656
Expires Ma 19, 2021 -= o� My Commission GG 16.4385
Y ;i s Boa Expires 11/3012021
Revised 11;10!201.6 N�9rF()FP�p�`or 6ondedThruBudgelNoterySerylces