HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
BUILDING&ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCIE, FL 34982
SHREW
(772) 462-1553 FAX 462-1578
CHAINGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERTMT
PLEASE SELECT ONE OF TITS FOLLOWING:
CHANCE 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 he 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
commeneing any work.,There is a Si0.00 fee for the Change of Contractor.
CHANGE OF SUBCONtRACCOR—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 PERti'Irr—The cancellation of a perni t-is.acceptable only if no work has been done.
Cancellation of permit is to be signed anti notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date:
Permit Number:
Site Address: C a o 1x
State License SLG License.
Original GC,subcontractor or owner/builder
lt•1 State License(-(' ,fir)751z- SLC License_1 �S
Ne►1 bC,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 change of
contractor/subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF C1t1'NER(or oaTcr/buitder) SIGN 'RE GF`E�� [.COti rRAC70R(or new GC.as app!'si:able)
AM PPIi1T NE f
PRIGr�p41E,�ftfJi7 1'" LG(Cilblt
State of Florida,County orst.:Lucie County State of Ftoridu.County of St.Lucie County
The following utstntntent was acknowledged Wore me this Ilowing in ru![�rnt was uckh ledgcd bgfarc mN this
dayof 20`,by 411ay nft5S 30 p=1°y
-who is personally known to me personally know% to
or rho has produced as ID. u;e+ o has produced!. as ID
signature of Nutan• Date Signature of sotan Date
Revised 04/15/16
-. .
tary Public State at Florida
' ndra Leone
..i{ 47
Gammisston GG 020251
c� Exptras 08l10t3020
PERMIT# ISSUE DATE
-- - PLANNWG& DEVELOPMENT SERVICES
�' ' 'R f Building&Code Complianee bMsion
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
D R HORTON INC
have agreed to be
(Cum .
pany NameJlndividual Name)
the PLUMBING Sub-contractor for AQUA DIMENSIONS PLUMBING SERVICES
(Type of Trade) (Primary Contractor)
For the project located at �5 C�LJ�J�Q 1
(Project Street Address or 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 Subcontractor notice.
CDNr5 OR SIGNA_,�E(Qaaniter) tGNA RE(QaaUfler)
Brian W Davidson
PRIM'NAME PRtI T N ME
CRC1327068 e'CC 655
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
state of Florida,County of Brevard State of Florida.County of
forryolag instrument wai'ggued bebm we f day of The foregotag ioatrument wu signed before me tbit day of
24/ y by
wbo b persunaay Yaow,101t r has produced a wbo is personally known_or boa produced a
as identfflcatlo4. vvT� as ideati cation.
- "�—
- — STAMP ._ STAMP
Slgaature of Nalary PublicSignature Wintery Public
&400_4 Leone &;dM!•cons
Print Name of Notary Public Print Name armatary Powc
° Notary Public State of Florda :..
rma
Sandra Leone, Notary Public SIG of FWrida
Revised 11'I6, My Commission GG 020261 StltxlKn Leone
ory Expires OW102020 My Commission GG 020251
ad� _ExpLas0911012020