HomeMy WebLinkAboutChange of sub-contractor, plumbing3 PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
a �
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1.553 FAX 462-1578
CIiANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
RLEASE SELECT ONE OF THE FOLLOWING:
CHANirF OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the new 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 C'onimencetnent must be filed in the new contractor's name
fqr job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
comp acing any work. There is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the Letieral contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERNAIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the perinit.
Date: of c� Permit Nunilter: Zt� d Z� b J` � .
Site Address: _ —/z4A—
c:;,tit ✓
t 1 t)/°,� t-f�r'" I.:Ihn A/1 YlC Slate License "f�s!I %�? SLC Ltcense—,
Origi I GC, subcontractor orowner/builda I , t t� tit, SI- �
c
k. C.:s tt �'.)t rt , Y"� C- Stage License ( {` t �(.;�iC "?t 3 S1.0 license •3C) `7 `7
Ne�v G subcontractor
Reason for Cancellationv,-
The undersigned does hereby agree to ►ndenr»i fy and hold harmless St Lucie County, its officers, agents and employees from all
costs, Pecs or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
act !subcontractor or cancellation of pennit. i1 permit cannot be cancelled i " �n-k has been performed.
aa�
SKYNTATUR7010�1
IUR (or ow1enb ikier) SIGNATURE GEi\ CC) lfftAcT611(or new CIC, isapplicable)
-�t*' :sa15R L PRINTN.�att _.,David Price
State of Florida, Couu:-y of St. Luck County
1 be following instrinnentt was ac.know I dged before Inc this
_ clay ot_
20 2ut,,, ,!_/ SA 1 "rely
_.__.._......._.....__......._._.-__
....-._lvha is personally known to ma
or w4p ha, produced
;is tD.
signature of Notary
Date
a�RHONDA$ ROWE
ro��,av
Commission # GG 104656
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Nag Expires May 19, 2021
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fFOFF °� Bonded 7hruBudget Notary Services .
Star; of Florida, Count} of Si. Lucie County
Tliti lollowing instr mtuu sea, ;iekuonletiged betiire me his�r p
----.-day of 202 ' u
----•-. --_" - who is personally known to
me or crho as produced__--- a's' ID.
5iguaturc of lotan• Date
N•Y °p4� Notary Public State of Florida
Karl J Hartel
My Commission GG 1643e5
'��� ' Expires 11/30/2021 f
PERMIT it ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Complianee Division
BUILDING PERMIT
SUB-CONTRACTORAGR't EMENT
Hypclluxo Plumbing, Inc !lave agreed to be
(Company Name"`Individual Name) � h�I
the Plumbing _ _ _ _ SUb-contractor for i3a �tiuilders, Inc.
fTyj)e of Trade) (Prinuiry CoiAractor)
t
For the project located at � �t_�t %� �' € i' _ f t -
(PrOjeci Street Address or Property Tax ID =)
It is understood that, if there. is any change of status retoardin.g 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.
t'(7tiTR?1E:TCIR it"
aalificr)
Glenn A Davis 11
2IXT tia}fE
CBC 1261228
Cf)UN112 CER'rfFICATION i NIBER
State of Florida, County of Marlin
r
Ilse foregoing instruntenl uas signed before me this +, t dily of
1 A
`
who is pi:rsomilly lautstn" or has produced a
its ldenitiifficlition.
Siguaitt • of Notary Public
Printi\ati,c ot'Nutley Public
SUR-CONTRACTOR SIGNATURE (Qnalificr)
David Price
PRI\T NANIF
30791 St Lucie 00 / CFC1430015 State of FL
COt:NTYCEttTTPrCATIONi\t ►tlEfR
Strite of Floridii. Cofmt}of Palm Beach
The foretuing instrument :rus ued before me this _`- da) of
Y --
who is peesonalt) known or has produced a
s dettiCai .
. J C-) I -
STAMP
a I 4-�UT " �- -P
Sigrinture of Nutley I ubli -
Karl J. Hartel
Print Nance of Notary Public
° "' Notary Public State of Florida
Karl J Nartel
eMy Commission GG 1o'4355
'�o►Boa Expires 11/30/2021
Revised 11;1012016 BondedThruBudgelNoteryServices
o�P4Y+PU9(�p
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RHONDAS ROWEa
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Commission # GG 104656
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Nj9TFOFF���`Oz
Expires May 19, 2021