HomeMy WebLinkAboutChange of Contractor PLANNING &DEVELOPMENT SERVICES
BUILDING& ZONING DIVISION
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2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMIT
PLFASF..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 pennit. A new pen-nit 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 (S7,500 if A/C Change-out). A recorded copy trust be submitted prior to
commencing any work.There is a SS0.00 fee for the Change of Contractor.
_-k_-,CHANGE OF SUBCONTRACTOR-Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Fortis.'There is a S-4;0.00 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: 2,(,/1 _ Pertnit Number: I—la 06q�_
Site Address: 3bb�JbV
State License SIX License
Original GC,subcontractor or o%ener,'buiider
A, .� l istlr �ita) � F �1. Y1�.1t► Y State Licensc�� t_.t:7�5 � SLCLicense
Ncti 'C,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold hamiless 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
contractorisubcontractor or cancellation of permit.A permit cannot be cancelled If work has been performed.
SIGNATURE OFOWNL•R(orowncr/buildcr) �- SIGN'rll 'REGE`E L/C O�VfRACTURtorne«GC.usapphcible)
PROT .'TAME PRINT NAME
State of Florida;County of St.Lucie County State or F1066.County of St.LUcie County
The following tnstnunent was actotowledged'xfore me this fY ollowtng I 't-rument teas ack.n nvledged before me this
day of —0 by day of f tit _ 217 by
-ttdto is personally known«,me lf:26�_ is personally known to
or who has produced T is ID filer o has produced as ID.
Signature or.%otar) Date Signature of lotan Date
Revised 04/15/1c -
. -„u, ivetary public Stara of Flonda
'? Sandra Leone Go2ozst
o tJl'/Cvmmission a
�z, Expires 0�8i1012020
F
RANT# { --O q[ ISSUE DATE
PLANNING& DEVELOPMENT SERVICES
i Building&Code Compliance Division
k � yy.
BUILDING PERMIT
SUS-CONTRACTOR AGREEMENT
D R HORTON INC have agreed to be
(Company Nturidlndividual Name)
the PLUMBING Sub-contractor far AQUA DIMENSIONS PLUMBING SERVICES
(Type ofTrade) (Primary Contractor)
For the project located at_ g�3 ' c�oi-�&c J �
(Project Street Address of Property Tax ID#)
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.
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CONTRA OASIGNA E(Qoag![er) - v__. a._._ rf tCNA REIQaaAtler) _
Brian W Davidson ,
PRINT NAME "PRINT NAME
CRC1327068
COUNTY CERTMCATIO14 NUMBER _CO_UNNTY' CERTIFICATION NUMBER
Stale of Florida,County of Brevard State of Florida,County of
.The fore oing Instrument was alined before mt th��day or Tic foregaing icstramsat was sitatd before me 06 _day of
200-1by
who personany koowao(or but produced a who is peramany known----or has produced a
asidentificadou. -asktenflileano
STAMP5G� STAMP
Slgnatare ar Notary Public Signature of Notary Public
�SahalYa Leon tSwd;-a Leone
Print Name of Notary Public Print Name orNotary Public
Notary Public State of Florida
(y Sandra(20tt8 yes, NotOry PT
State of Florida
c w nay Commits GG o2025t ? �: Sandra Leone
Revered 111 16` a�d� Fxplres o8/10/2020 y c , My Commission GG 02025t
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