HomeMy WebLinkAboutChange of sub-contractor, plumbingPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
s s
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CIiANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMTI'
PLEASEE, SELECT ONE OF THE FOL:L:OWING:
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 Commencement must be filet 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
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 at $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: 17, a • Jz)
Site Address:
Permit Number: 711' 0�7 9t�p
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a Cr State License C C1 7GI SLC License _2/_Z j.
Origi 1 GC, subcontractor or ownedbuild4 �, � t t.� p
t. C, � t_,J k. 6."1 0 \%J iIt } �`_ i 'ftr> l I-" c State License ('1 (° 1 d A CC) 5 SLC license ,3 0 "7 c: j
New G ', subcontractor ---------__.._._--
Reason for Cancellation 62A
The tindersiL*ned does hereby agree to indemnify anti 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 may arise as a result of this change of
act , /subcontractor or cancellation of permit. A permit cannot be cancelled i rk has been perforated.
$1(.WATUR1; OF OWCER (or owntrbuil8erl Sl(iNA"CURE Gtil\ _ t't)N1 RAC1't)R (ar new CC, as applirahle)
r?TH7 i �t-r U_, A. rn^�}�(��- PRUNTN.• ME .David Price
State of Florida. County of St. Lucie County
State of Florida. Counly of St. Lucie County
The following instrulnunl( was acknowledged balbre uw this The rollow ng us anent ua>;teknonledged betilre ntc this
it tv of 2(l0 . by �- � sA- Fiel cl �2 day of _ ._ __, 20�. b�•
i -...—..,---
/ .......Yho is pctsonally known to the _ -is p . orally k in to
of mho t, produecit _ .._ as ID. me or 3XR
pnaturducedas ID.
_-c.,��.____..
Signature of Notary Dote Sige of \afar'
a4PAypgpe RHONDA$ROWE.
Agi Commission # GG 104656 °`Y P�°4Karl J HerteiNotary Public state of FloridaExpires May 19,2021v My Commission GG 184385FF� Bonded7hruBudgelNotaryServlce8 ?�A,o�' Expires 11I3o1202t
f
PERmrr # I I ISSUE BATE
PLANNING & DEVELOPMENT SERVICES
Buildinc, & Code Compliance Di -vision
0- 0--aw BUI LDING PERMIT
SUB -CONTRACTOR AGREEMENT
Hyppluxp Plumbing, Inc
haveagreed to be
(Coinp4tiy Name-iffidividual Name
the Plumbing Sub -contractor for R44w Builders, Inc,
ff�I)c of Trade) (PrimaryContractor)
For the project located ato'nga.-POI)m ?wp a-zo Vir'
(Prqjeci Street Address or Property Tax ID 4)
It is understood 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.
CONTRACTORSIGNA , WRM.Iualifice) SUB -CONTRACTOR SIGNATURE (Quallifi6r)
Glenn A Davis 11
PRINT' IN, kN, I F
CBC 1261228
COUNTY CERTHICATION NUNI RER
State or Florida, Conpityof Martin
Ilie foregoing instrunicul was sh, nd before we this > day of
by -�G&Rn.. A Dffis
who is personally known 1!!�_or has produceda
as identification. I
I I L. crid, ,
Signat&v-of Notary Public
Print Natue ot'Notary
Public
David Price
PRINT NATNIF
3W91 St Weie Co / CFC1430015 State of FL
COUN'ry-CEIC11FICATtON NURNIRER
Palm Beach
Slate of Floridia, Cotility of
ThL rure-goffig instrument was sAg ietl before me this da) fit'
who is personalty known or has produced a
as
STAMP S, f,
Signature of Notary Piiblil
7�-
,karl J. Hartel
Print Na ine of Notary Public
�IeF rda
State
of 'o
rte
,0( P�oe,, RHONDA S ROWS Notary Public Stat, 9 of Florida
Karl
Commission # GG.104656 Karl J Hertel My Commi_, a ar
on GG 1 43
Expires May ig, 2021 MY COMMiwion GG 164385
� r._ 1 1/30
Expims 11/3012021
Revised 11 2016 Bonded7hrufludgetN0180ON115