HomeMy WebLinkAboutChange of Contractor - PLANNING & DEVELOPMENT SERVICES
1; J BUILDING& ZONING DIVISION
2360 VIRGINIA AVE
!ti FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR.SUBCONTRACTOR OR CANCELLATION OF PERINIT
PLEASE SELECT ONE OF TIM 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 (a7,500 if A/C Change-out). A recorded copy must be submitted prior to
commencing any work.There is a S>0.00 fee for the Chnnge of Contractor.
CHANGE OF SUBCONTIL-WTOR-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: _ Permit Number:
Site Address: J,IUt� DL
State License SLC License
Original GC,subcontractor or owner;builder
�L�t
-�/���Cl �JiQtte'�►1`� g�`> 1 t`Wltrl�l' State License��-�'(jt7��s �e SLC License L�? ��
Ne4XC;subcontractor
Reason for Cancellation
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 from any'and all claims of action for any reason,which may arise as a result of this chance of
contracton'subcontractor or cancellation of permit.A permit cannot be cancelled if nvock has been performed.
�1
ZAI
SIGNATURE OF OWNER(or awncrIbuilder) SIGN RE CiEN'E L COe,17fRACI'OR(ur nets•GC.as applicable)
PRitlT `I. lE PRiNTNANI 'Op 1' F.G!(!/lJ/f(
Stute of Florida,County of St.Lucie County. Stare of Florida,County of St.Lucie County
The following tnstrument was acknowledged berore me this ng i size rnt was uc ss'tedguti befure me this
day of 211_ _ by day of 0�1-1 �t by
wbo is personally known to me J-_,_t1J_who is personally known to
or zebu has produced as 1D un o hus produced as ID.
Signature of Fotary Date Signature of\star} Date
g-vireo 0•tJ15;'_a p�, ,;�
=; idolaty public Stata of Flonda
Sandra Leone
iT a )251
'A an-
-,mm,_sian GG I_C 251
e, Expires Oa1tU12020
-t
E
ERtwrfE
�� O(_ � ISSUE DATE
PLANNING& DEVELOPMENT SERVICES
R,. Building&Code Compliance Division
a $
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
D R HORTON INC have agreed to be
(Company Name/individual Name)
the PLUMBING Sub-contractor for AQUA DIMENSIONS PLUMBING SERVICES
(Type of Trade) (Primary Contractor)
For the project located at
(Project Street Address or Property Tax ID#)
1
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 SL Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice,
CONTRA�SIGNAii5 o- iiiwi S(CNATURE(QnsUikr)
Brian W Davidson
PRINT NAME -- -- PRf�pTT NAME
cgl1/N-�
CRC1327068
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of hlorids,County of Brevard State of Florida,Coacty of
Thee foregoing instrument was signed before me thl day or The foregoing instrument was st utd before rue tbL day or
--Q- 20& ,by .20 ,by
who Is per o2lllly� �5lnownAar hse produced a who Is penonsity known__,or has produced r
� u identifiesHoq. as MeoHaestlo
STAMP STAMP
Signature of Notary Public Signature of Notary Public
saslk Leo, saH#a Leon
Print Name of Notary Public Print Name arsotary Public
tif'�'r'4r1 _
°kr Notary Public State of Florida ° wry,Public State of Florida
Sandra Leone =° h Sandra Leone
Revised 11 Ili' ` idY Commltslon GG 020251
"ni oyr,d� Expires 08/10/2020 y c �` My Commissbn GG 020251
�yo,tic Expires oaNO/202t1