HomeMy WebLinkAboutChange of Contractor b
PLANNING & DEVELOPMENT SERN'iCES
BUILDING&ZONING DIVISION
o ' 0 i fll ,
2300`'IRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF COI\TRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMIT
PLFASF..SELF,CT ONE OF Ti it 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 Noticc of Commencement must be filed in the new contractor's .name
for job values greater than 52,500 (S7,500 if A/C Change-out). A recorded copy must be submitted prior to
commencing any work.There is a Si(1.00 fee for the Change of Contractor:
CHANGE OF SUBCONTPL-kCTOR—Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form,There is a$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been Clone.
Cancellation of permit is to be signed and notarized by bode the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: ?S_i_`_' Permit Number:
Site Address: t� �b`ft�1tlt-sL- t
State License SLC License
Original GC,subcontractor or owner/builder
E UCI�i st lr�t l � Z��CI�Y 1Y_l t f li State License��.�' l t j�7SLC License
Nei C,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify anti hold harmless 5t Lucie County,its officers,agents and employees from ail
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractorlsubcomractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or oimedbuilder) � SIGN REGENE�L/CON-RACTTOR(urrnewGC.asapplicuble)
PRINT NAME PRINTNA.LtE �l�C�/�L'f''�L-rrfAWL
state of Florida,County orst Lucie County State of Floridu.County of'St.Lucie County
The followinb instn+ment was acknowlWged before me this a ollowing i tp ui ent was ac tcledged before me this
day oP 20—byLSt_Wday of y
who is personally known to me ho is petsonally knottm to
ur who has produced_ as ID the, u hus produced4 as ID.
Signature of Tutur) Date Signature of Natan Date
Revieed C4/15/t$ -
Notary Public State of Florida
Snpdra LeCne
f 4 jpA commission GG 020257
o�N ExptreS 081'1012020
Em,:T,#
DATE
PLANNING& DEVELOPMENT.SERVICES
Building&Code Compliance Division
c�
wx R x BUILDING PERMIT
i
SUBCONTRACTOR AGREEMENT
0 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 at3� �j t(�Q
(Project Street Address or Prop"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.
COgaOR SIGMA `_E(Quanfter) _ .,w _._ IGNATRE I
Brian W Davidson
_ r 4
PRINT NAME 'PANT NAME
CRC132706$
COUNTY CERTInCATION NUMBER COUNTY CERTIFICATION NUMBER
State of Ftortda,County,of Brevard State of Rodda,County of& 4 Il�
The foregang instrnmeot was tdgeed before me thU9l day of The foregoing kntearoe'att1W_es tfyaed before we 1WQJ day of
----ail_- 2 by 201DY
wbo Is pmaos y know or boo produced■ Who is Pe. naUr kaowtor lus produced a
uldeadaeatbtp aabdrnfbfhado ..{�1l,[�
STAMP P u' STAM•
Slgmtare of Notary Public STAMP
of Nafary Pb1k'
S&Him Leone s&fra'Ya LeoHe
Print Name of Notary Pabtk print Natno�f tlotaey Pabtle
Notary PublicState of Florida Leo
Sandra Leone Pt bSoi3ty Public State of F'torlda
Revised 11 16` ` My Commlaelon GG 020251 ? `� Sandra Leone
ar p Expires MI012020 My Commission GG 020251.
�t'w fldt Expi es 08110/2020
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