HomeMy WebLinkAboutSub Agreement[ZRAIT # 135LIE DATE
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PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
n . 5 ':5yer � `� d� e �'�. W - �• �� er f7c Dave agreed to be
(Company Nimellildividual Name)
the-R,00f ina _ Sub -contractor for P, N ram, HOME
(Type of Trad (Primary Contractor)
Fo.rthe project located at U� Jam- Dj- Po,-4- .. Uj e , Pe- 34 q
(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 Regulati n Division of St- Lucie County will be advised pursuant to the
ding of a Change of Sub -cant car notice.
CT R A RI (Qualifier) T►ZACTOR STGNATURE (Qualifier)
0,,,' ?'� 2. ? v3u I. Via• 1'0- •c ccC. i
PRJNT NAME PRINT NAME
COUNTY CERTIFICATION NUP IBEIZ
State of Florida, Caanty of
The foregoing instrument was signed before me this
U4l i by -hartI-
wlko is personally known +for has produced a
as idenriticayivn-'•.
STAMP
Signatu re of Notary PLimic
Print Namc of Notary Publit
rtiyrti•�,t ALE%AVICORIAJUR.4A6-LAFA
Knxaty �u61k - Stare of Florida
,y Com�Isslan is 0 36MI1
Q� s4J MY Lumen. Exoi(e$ ins 21. 2013
rtsrnugh National Notary Assn.
Revi;.ed 11116/?016
COUNTY CERTWI CATIOPF�yN�t.&TRCP,
State or Rorido, County of l c. vtriin
The fofore�goi�ng instrument n•as signed before me this �'3 dal of
tom`` xC)n ,20}I by
,who is personally Imotiwax or has produced a
as identification.
STAIN-1F
Sirnaturt of Notary P 1-
Print Narne of Notary Public
TNEREShJhFfC
Not
ary Public - State of F Votida
yC�, 1Q Commission # GG 2023E)1
My Camnr. Exires Apr 1, 2D2i.
@9nde6 through National Notary Assn.
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CA.tiICELLATXON OF PERMT
PLEASE $ELECT ONE OF-111l✓ 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 trust be filed in the .new contractor's name
for job values gmater than $2,500 ($7,500 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.
AX CHAINGE OR 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 Grange of Sub -
Contractor.
C_4NCELLAT€ON OF PERMIT - 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: vf-�. a-3, -2072.1
Permit Number.
Site Address: +7 CO,tLLrr-�P—+ f-+- Pi3V+St tL4Q?-, �' ►
TP l Vn*n r-Sa"C S S 101-1i S+ State License CCLI 3307a;,C License
Original GC, subcontractor or owner/builder
s'► gx-Ffm f7h?—1 I _ State License33�I,C License
New GC, subca actor RD04-� pe-t"!�s -
Reason ForCancellaltion ! Ss Pirl. ctl cylar -` jn-1mc- -1,01r
The undersigned does hereby a e to indc)rnify and bold harmless St Lucie Couealy, its officers, agents and employees from atl
costs, fees or d - es arisi fi•vrn any and all claims of action for any reason, which may arise as a result of this change of
contractor/ tracto r cancellation of permit. A permit crnoat be cancelle tv rk has been performed,
GNPG.T/�j O, WNUR for erlblJitder) GEN2RAL CpONTRACTOR (or o� w CC', as applicable)
PRSt7 i ME�' _ § PRINT NAME_ Wise' a. -fq
Scat fMorida, unty.ofSt. Lusic Counry
e ibl ' g inst
rument was aclmmvledged before nee this
day of, f+f 'i .20 ty r
—����'+i _ _�wlte is percorially icnu+vn to me
or who produced_ z—,—___as [t).
signature of Notaq t
�`�"W' AG.`.XA SRfi0RI4JIlRaUo, EAfiA
•,� H4"pv"c SlateOPFlorida
ummiman ; CG 360013
Revised J4/l5/i5. =,cr Fs?,`r My Cc' rr. ZCX*05 Ju129. 7023
3a idEd thrOUP HarI04 RaW.Assn.
State of 9orida, Counra of St. Lucie County
1e foilawing insmlment was nalmawled ed before me this
.- ---yho is ptrimnalty known ro
orw ihasprod as1).
Signature ai N pare
'ter• "�}
THEI€E5AJAFFE
14"•-
Nctary Public -State o! Flurica
CUmmissicn 1! GG 2L123o1
My Lamm,
Expires Apr �1, Z022
Bonded through National Notary As>n.