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HomeMy WebLinkAboutChange of Contractor II ANN PLANNING & DEVELOPMENT SERVICES = BUILDING &ZONING DIVISION 2300 VIRGINIA AVE -- FORT PIERCE,FL 34982 (772)462-1.553 FAX 462-1578 CHANGE OF CONTR.aCTOR SUBCONTRACTOR OR CANCELLATION OF PERMIT PLEASE SELECT ONE OF TILL•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 pennit application must also be completed with new contractor information and signature. A new Notice of Commencement must be tiled in the new contractor's name for job values greater than S2,500 (S7,500 if A/C Change-out), A recorded copy must be submitted prior-to cotnmencing any work. There is a S50.00 fee for the Change of Contractor. ____CHANCE OF SUBCON'1'IZACTOR—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 PERM1'I'—The cancellation of a permit is acceptable only if no work has been done. Cancellation of permit is to be sigue(i and notarized by both the owner and qualifier of record. There is no fee For cancellation of the permit. Date: a Permit Number: 0.'6 Site Address: State License SLC License Original GC,subcontractor or owner,'builder n)G ' lr State LicensW. 06r1�Z SLC License at NesKOC,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 contra ctor(subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed. SIGNATURE Of 00`NER(or owner/builder) SIGNgPdRF GEN-L L/CO\iRAC70R(or new GC,as applirubte) PnItiT :IA•;E PRINTSAME r�IJCJCl'' LG(G11Jtyi= State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County The following instrument aas acknowledged before me this TliJolloKinb i st mrnt K u ocluedged before ma this day of •20,,.by �'�day of whu is personally Lnuwu to me lhnia ispersenalty know to Or who has producai as ID. are c o has ppr(Wmed as 11), Signature of Notary Date- Signature of.Notary Date Revised 04/15/1c ' • NOON Public State of Florida 'ySandra Leone a idq Commissrorn GG 020251 •Ga Eqpt gc 08110r2020 PERMIT# l '� _O 15SUE DAtE PLANNING& DEVELOPMENT SERVICES 0 Building&Code Compliance Division BUILDING PERMIT SUB-CONTRACTOR AGREEMENT 0 R HORTON INC have agreed to be (Company Name/lndividual Name) the PLUMBING Sub-contractor for AQUA DIMENSIONS PLUMBING SERVICES (Type of Trade) © v (Primary Contractor) for the project located at o O � �1 tM Q.� —i (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 Cade Regulation Division of St. Lucie County will be advised pursuant to the filing of a Change of Sub-contractor notice, CONTRA �SIGNAIiWiFul } N tCSIGNA RE�QoellRer) �~~' Brian W Davidson �--- PRRYI•NAME PR T N ME CRC1327068 COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER Stole of Florida,County of Brevard Sate of Flortdd,County or The foregoing instrument was slltaed below tae th&21 day of The kreBatag lwteomeat wss slgaed before roe ih}r daq of ,20_.by who Isp y knawqaor boa produced■ who Is perrooany known_or bas prodaeed a asldeotlikadoq . asWenNOe>•tloa STAMP STAMP Signature of Notay public Slgoalure of SONY Public &100-4 Leon, �thp(Ya L2o�t2 Print Name of Notary Public Print Name alNotary Pohik ,� Notary Pubiic State of Flodda �,g Sandra Leone °�,,� Not PuGFe Slate of Florida Revised 1 L 16' JW My Commission GG 020251 ? Sandra Leone or W Eeptrrrs 0811012020 y cy My Commis(1/2 G0 020251 +6}ot ExQgesayi0/2020