HomeMy WebLinkAboutChange of Contractor 5
.: _ ry.,, PLANNING & DEVELOPMENT SERVICES
BUILDING&ZONING DIVISION
° 2300 VIRGINIA AVE
- - FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERINIT
PLEASE SELECT ONF 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 ne�v permit application must also be completed with nett^
contractor information and signature. A new-Notice of Commencement must be filed in the new contractor's name
for job values greater than S2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior to
commencing any work.There is a S50.00 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 a S50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation ofa pennit 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: 2J_lp_L:1' Pertnit Number:
Site Address:
✓� t►t. e -------_,-State License SLC License
Original GC, ubconiractor or owner/builder
<� J '(.�, LC.�``��tl..-tt"41�t�)t t�P State License,��.�'��(�'�775�1: SLC License ���'�i�
NeiljjC,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents hnd 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
contractorlsubcontractor or cancellation of permit,A permit cannot be cancelled if tigozk has been performed.
SiGNATUREOFOt1.'NER(orownerlbuilder) SIGIti RE GENE LC01'rRACTOR(or ncw GC.asapplicable)
PRINT `Ia),.+,E PRINT NAA1F_ t(J�7 `t �L—Ltd/t��j(
State of Florida,County urSt_Lucia County state of Florida County of St.Lucie County
The following instrument wms acknowledged before me this t follow'ing iTt�, in at was ock wledgtd before me this
day of_ ,2 .by day of '2( by
who is personally known to me T w'ho is personally known to
or-who has prnduccd as 11). me' o huff produced as lD.
Signature of iliutan' Date Signature or Notan Date
r,gr�r ;.Notary public State of Fonda
' Sandra Leone
idy Commis on GG 020251
' `c�> EY;.4zs O�I10/2020
8'3
PERMIT# l`j�(� �t1�Y ISSUE DATE
PLANNING& DEVELOPMENT SERVICES
�i Building &Code Compliance Division
o M
BUILDING PERMIT '
SUB-CONTRACTOItAGREEMENT
D R HORTON INC have agreed to be
(Company Namdindividual Nome)
the PLUMBING Sub-contractor for AQUA DIMENSIONS PLUMBING SERVICES
(Type of.Trade) (Primary Contractor)
For the project located at �� ��� 1;%p:
(Project Street Address or Propeity 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.
CONT�51GNA (Qoallf er} R SIGNA . RE:(Qwgller) _w
Brian W Davidson
PRINT NAME -PRflqT NAME
CRC1327068
COUNTY CERTIFICATION NUMBER_ COUNTY CERTIFICATION NUMBER
State of Florida,County of Brevard Stale of Ftotidn,County of
The fareaatoglastrumeot was slgaed Ware nee tti 7^1 day of The[artgoiag iattromem was shoed before me t4 day or
jawho itprruoaay kaoirar ba prodoted e. wlio u pe oB!bow or bsq produced■
as ideatifiradoo. as Identification
STAMP .. STAMP
Signature of Notary PubUt Sipoarwe o[Motary Publk
c ND�YLt Leone cS(W/-q Leon
Print Name of Notary Public Print Name of Notary Pubut
.° Notary PubAc State of Nlodda
Sandfa 3' Ut �sr Notary Public State of Florida
Revised 11 16 ` My Gnmmfgs(E on GG 020251 ;° Sandra Leone
d� Expires oaltol2020 y c My Comrtission GG 020251
ryi d ,Expires 0a11012020