HomeMy WebLinkAboutChange of Contractor a
PLANNING &DEVELOPMENT SERVICES
BUILDING&ZONING DIVISION
y 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)46271553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR_OR CANCELLATION OF PE&N-1T
PLFASE SELECT ONE OF Tlil?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 pennit 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 ($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$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERi1'11T—The cancellation of a permit is acceptable only if no work has been done.
Cancettation of permit is to be signed and noiari-/.ed by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: - Permit Number:
Site Address: bD� 61+W(k5 Rtx- OL
State License SLC License
Original GC,subcontractor or ownerrlbuilder
�i.,�ii t�t It' State License�,.:�' {`� :S?�L- SLC License`
NesVbC,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
conimciorlsubcontrnctor or cancellation of permit.A permit cannot be cancelled if work has been performed,
slGVATURE of o%",r-1 for awnerlbuilder) SIGN, RE GEtiE�CONTRACTOR(ot•new GC.as appheabi�)
PRINT NAVE PRINrNAME �Gdt'L'f ZL(C(106L
State of Florida,County of St.Lucie County State of Floridu,County ofSL Lucia County
The following instrument was ncknowletlged before me Hits fy Hawking'i ttuittent wms acknmvledged before me this
dayof '0_by ay
of IO_(aby
-vvho is personally known tome IIITTT '"` fi a is personally known 6
or who has ptaduced�lasiD, me oohhuu�pmduced �•�t�t astD
Signatureof:Nuiar- nhtc Signa.tureor\titan' Date
Revised 04/15/15
` h
.;r 411 Notary Pubrlc State of Florida
u�
Sandra Leane
i My commission GG 020,51
,.�c°`a Expras 0811or2020 � - -
a
PERMIT# 1—'1 _Q`O J� ISSUE DATE
t 7_; PLANNING& DEVELOPMENT SERVICES
Building&Code Compliance Division
BUILDING PERMIT
suaco TRACTURAGREEMENT
D R HOR70N INC have agreed to be
(Company Nttrtttfindividual Mine)
the PLUMBING Sub-Contractor for AQUA DIMENSIONS PLUMBING SERVICES
(Type.of Trade) (Primary Contactor)
For the project located at
(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 Sub-contractor notice.
CONittAC OR&iG E(QaaNlier} W SIGN lltler}
Bfian W Davidson
PRINTNAME r!RINFKA E r� /
CRC1327068
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER '
State of Florida,County of Breyard state of Florida,Cooaty of
The foregoing iwtroment was skoed-hefam no thin? R day of Toe foregoing lwtrnmeat was stud Detore we thls day of
20 ,by
who Is persoastly know' ae has prasioaed_r who Is peneoaq kuow�or hus produced a
as identificatiao. as IdeaNffics
STAMP STAMP
Slgoamre of Notary PutrTlc .57g'oarure of Nofiry Puhlk
sanal�a Leohe tS Wy -a.Leon
Prior Name'of Notary Pahik Prior Some OfNotary Pnblte
p Notary Public State of Florida
Notary PuWtc Slate of FWrida
ApSandra Leone :° Sandra Leone
Wy�� ' My.Commiss{on GG 020251 Myn,misston GG 020251
Revised i 1 18. d� res 0a/10l2021I
ara Ems ExpiresOaN0r2020
. .— '