HomeMy WebLinkAboutChange of Contractor Q •
PLt.1NING &DEVELOPMENT SERVICES
BUILDING&ZONINGDIVISIOIT
0 2300 VIRGINIA AVE
FORT PIERCE, FL 34982 -
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATIOtti OF PEP.,MT
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 permit.A new permit 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 must be submitted prior to
commencing any work,There is a$50.00 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-
Coritractor. .
CANCELLATION OF PERMIT—The cancellation of a permit is,acccptable 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:. _ Permit Number:
Site Address
State License SLC License
Original GC,subcontractor or owner/bui[tier
r`" �' )- �tl��ti tt• ~" i� State License(7.F !06* SLC License
NeflLOC,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
contracton'subcontrdetor or cancellation of permit.A permit cannot be cancelled If work has been performed.
�2
SIGH'ATt:IRE'OFOWNL'R(or an•ncrfbuilder) SIG\ E LC0N7Re1CTUR(urr/new Ge.usappRubte)
FAS2IT":1ahtE 9R1\T`AMEsl� ZGf�(/t�1Fj'
State of Florida,County or St.Lecie County State of Florida,County of St.Lucie Couniy
I he fallowing insttuntem uas nchnowtedgrJ before mt:this r:ollowing i 7mment was u cledp cd before me this
day of �U by Jayor y
who is pcNunaily known to me `fio is personally known ib
or trho has produced as ID me o hus producrJ a,II?
Signature of Notary Date Signature 6f Sotan Date
Revised 04/15110 ;
"vy [Sofa^?Public State of Florida
f+ I, Sandra Leone
ommtssion GG 020251
. • .;;a'g Ezplras 0EI1(1t202(T
4
193
PERMIT* 1� ISSUE DATE
PLANNING& DEVELOPMENT SERVICES
Building&Code Compliance Division
BUILDING PERMIT
SUB-COiVTRACfOR AGREEMENT
D 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)
ti
For the project(mated at 652A
(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.
c4via�SIGM OltiQo.unKf _ R SiGNA n crier) _`
Brian W Davidson
PRINT NAME PRi T N ME
CRC1327068
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of Brevard State of Florida,County of
Th foreQoiag Instrument was signed before me thi��day of The roregoicg imtraa+eat was signed before me this_day or
who is persausay hoowlf for ha produced■ who h personaby known--or has produced a.
asidtntifteafloq . v` a�Identineado,
STAMP STAMP
Signature of Notary Public Slgaaturs arFt6t�ry Puhlle
sa4#4 Leant sa`rolYa l evhe
Print Name of Notary Public Prior Numebr Notary Pubtie
° Notary Public State of Ftorlda °;,,r° Notary Public State of Florida
Sandra Leone Sandra Leone
Revised i t.15' ` My Commission GG 020251 W . My commission GG 020251
"�wndP Explras otNtono2o It, , exores aat1012020