HomeMy WebLinkAboutChange of Contractor PLANKING'& DEVELOPMENT SERVICES
~"At BUILDING & ZONING DIVISION
a e
_ 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE
H NGE 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 of record 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 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
commencing any work.There is a $50.00 fee for the Change of Contractor.
X 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: 4-17-17 Permit Number: 1704-0145
Site Address:
Aqua Dimensions Plumbing Services Inc. State License SLC License 18628
Original GC,subcontractor or owner/builder
South Park Plumbing State License CFC1426656 SLC License
New GC,subcontractor
Reason for Cancellation Original Sub Contractor to busy
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers,agents and employees from all
costs,fees or damages arising fi•om any and all claims of action for any reason,which may arise as a result of this change of
contractor/subcontractor or cancellation of permit.A permit not be ancelled if work has been verformed.
SIGNATURE OF OWNER(or owner/builder) SIGNA"URE GEN CONTRACTOR:(.r.e,,�, plicable)
PRINT NAME PRINT NAME .�
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowleda d before me this
day of _20_,by _A'1 01day of 6��A 20n by
y who is personally knoxrn to me 241V� who is personally known to
or\dio has produced as ID. or�dio has produ d as ID.
signature of Notary Date Signatu. N ary Datc
Revised 04/15/16 BOBBY J PAMRSON
`• PRY COMMISSION#F0921154
EXPIRES September 23,2Ut9
1..-... _.. FloriOaNWarY9���eom
l �
PERMIT# ISSUE DATE
PLANNING &_ DEVELOPMENT SERVICES
Building &-Code Compliance DivisioinICOUNTY
B U i LDI NG TE.RM ITWON
SUBCONTRACTOR AGREEMENT .
�c3� •. �p.rl� +17�u.-�.Io;n�. have agreed to be
(Company Name..[ndividual Name}
the -.Sub-contractorr for �,n, �,p ory}�•uL�;,,;, 5,,�..
(Type of Trade•. (Primary Contractor)
For the project located al UZ Z t 9'A �,, .::j.�n,�„ .at"'ft- ' ?WrA* yS(Da.-s p l- Mt -goals
(Project Street Address or Property Tax.1 D.#)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the.Building and Code Re gulation-Division of St..Lucie County will'be:advised pursuant to the
filing of a Change of:Sub-contractor-notice:
c:�----
------------------
RACTORSIGNATLIRE(Quatifer) ;'"1 ) NATURE(,Qualifier)
PRINT NAME PRINT-NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTiFiCAT1ON,NUN,IBER
Shie of Ourida,Coanty.of XYActr�;r-N State of Florida,Couniy,of SA.Lto e
The foregoing instrument was signed before me this 11 Rhday.of The foregoing instrument was signed before me ibis, _�daOy of
�R 201.by Q..ArA.-; WeLw l-e`1 �l,' zo��,by
.who is personally known or has produced a who is personally known fins produced a
as identification. s identi at
ST.kmp
5ignatare of 1 r}'F blir Signatu of 'otarp Public
44-cr'syr. ..
Print Name of Notary Public Pnnt Name of Notary Public
CMAO)WINTERCOW, -
�089Y J PAT[ERSON Notary Public•Sfafe of Florida
` : _ Commission-'M;GG 062220
MY'COMMISSION#FF921154' � My Comm.Expifas Mar 18.2021
-23.2019 °,°` .flooded through National Notary Assn.
Revised 11nfi201 6 EXPIRES September
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