HomeMy WebLinkAboutChange of Contractor a '
.;, PLANNING &DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 3.4982
(772)462-1553 FAX 452-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE.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 %vith.nety
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 Changc-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 SUBCOiNTI-4C`i'OR-Subcontractor changes are to be completed by the general contractor.
The new subcontractor must till out a Subcontractor Agreement Form..'There is a$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERNIIT-The cancellation of a permit 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: 'ZAP ��' Permit Number: l�( -, -yLL
Site Address:
State License SLC License .
Original GC,subcontractor or owner/builder
CI�J i t lt✓''i l�t�'a�` , 1_3 f State License w t r .� SLC License j S(L--
Net C,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harniless St Lucie County;its officers,agenis 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.
. ,I 1l ppp i
:f7 - C
SIG\ATURE OF Ott1CR(or o�tzterlbuitderj SIGN RF GL\E L CO\fRACJTUR(or new GC,a,uppliutblr)
PAINT NAMIE L PRINTSAM t(J "� L(G!/l�/ji'
State of Florida.County of St.Lucie County State of Florida.County of St.Lucie County
l
The following instrument was acknowledged before me this 11 e following i strum"nt WAS acknp�iedged brfurc me this
daymf °0 .by dayof ,?Oey
who is personally known q)me personally known to
or who has produced as ID me, . o has produced as 117.
signature of otury Date gnature of Notary Date
Revised 04/15/16
`ram
°«. Moiety public State of Florida
r Sandra Le�me
' .o t�'�c mmission GG 020251
c�' Erpt:es 081101�020
r
1 a�
ISSUE DATE
--- PLANNING&DEVELOPMENT SERVICES
1 '' ` Building&Code Compliance Division
o _
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
0 R HORTON INC have agreed to be
(Company Narndindividual Name)
the PLUMBING Sub-contractor for AQUA DIMENSIONS PLUMBING SERVICES
(Type ofTrado) (Primary Contractor)
For the project located at?532- ( �\OU46w-
(Project Street Address or Pmperty Tax ID N)
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
Sling of a Change of Sub-contractor notice.
CO9ia0R4SIGV—a—Z1&WnfiW)— '—' .SICNA Rti7�l (Qoeasec}
Brian W Davidson
PRlNrI NAME P T N ME
CRC1327068
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County orBrevard State of Floddo,;Caoaryof
The foregoing in*vatent was zlyded berm me tb �duy of The foregoing instrument wits slyutd before roe this_day of
202)vy .20_,,by
who is perwaaay known_.or tint prodored a who is pemmtly known_or bis produced■
es ideatifindn% as identilfrallaa
STAMP ''
STAMP
Sigoatore or Notary Public sigosture erNotw7 Pubik
Saildlra Leone SaM-a Leone
Print Name of Notary Public Print Name of Notary Pubtle
•tfr° Notary Public State of Fimlda r Notary Publio State of Florida
Sandra Leone r' Sandra Leone
Revised it,16`.. My Commission GG 020251 b� My cprnmisslon GG 020251
orw, Fxpirs508110l2020 "Y'i ;esDWIV12020
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