HomeMy WebLinkAboutchange of contractor70--C-1
Y
PLANNING & DEVELOPMENT SERVICES
BUILDING & .BONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
FAX 462-1578
(772)462-1553
RANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCL ATI OF PERMT
PFASL SELECT ONE OF T141C 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 mrith new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values grater than $2,300 (S7,500 if AIC Change -out). A recorded copy must be submitted prior to
commencing any work. There is a $50.00 fee for the Change of Contractor.
Xxx 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 S50.00 fee for the Change of Sub -
Contractor.
"'161" CANCELLATION 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.: March 31, 2021
Permit Number: 1905-0366
Site Address: 9431 S OCEAN OR CLUBHOUSE, JENSEN BEACH, FL 34957
TOTAL ROOFING SYSTEMS SPECIALIST
Original GC, subcontractor or ownerlbuilder
TOTAL ROOFING SYSTEMS "THE METAL ROOF EXPERTS"
New GC, subcontractor
Reason for Cancellation New Qualifier
License OCC1330768 SLC License
License CCC1332346 SLC License
The undersigned does 1 ereby agree to indemnify and hold harmless St Lucie County, its officers, genLc and employees from all
costs, fees or da s ar' ' 'horn any and all claims of action for any reason; which may arise as a result of this change of
contractorls n nce ation o€ permit. A permit cannot be cancelle k has been performed,
RE OF OWNER (or owner/builder) ERAL CONTRACTOR (or new CC, as applicable)
PRINT ;vlutl>;PRtNTNAME_
Statt of Florida, County of St. Lucie Cotmty Stare of Florida. Cotmty of St. Lucie County
The following instntme.�m, ,:,tqs aclmmvledged before me thfc
.20; ��, by
�•rL .�il/lZ T !�� tf.L�JG Ito iu penoonity Ivto..•n to nto
ar whu 1 as r ducal as ]D.
March 31, 2021
. �< at r of Notu t)atc
Revised
TNotaryracy A. Price
State d Florida
?racy A. Prime
W Commission HH 0e5816
pa Expires 03/27/2025
The following intmimenVjvas acknowled < bc�
_do, arKS 20�.by�1ypre me this
t e.
emu'
..ho'<�r ,fly ki
x wht asp uc�
as ID.
March 31, 2021
5ignnturc o
D na
sir ^o `•. THERESA JAFFE
Notary Public - State of Florida
Commission d GG 202301
't oFV My Comm. Expires Apr 1, 2022
Bonded through National Notary Assn.
PERiJ(T# ISSUE DATE
_ PLANNING & DEVELOPMENT SERVICES
l� = Building & Code Compliance Division
BUILDING PERMIT
SIDS -CONTRACTOR AGREEMENT
TOTAL ROOFING SYSTEMS "THE METAL ROOF EXPERTS"
(Company Name/Individual game)
the ROOFING
(Type of Trade)
Sub -contractor for THE W GROUP
For the project located at 3535-334-0001-000-5
(Primary Contractor)
(Project Street Address or Property Tax TD #)
have agreed to be
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.
Ui RA . OR STGNATURE (Qualifier)
--1 fi_ 2"v �
PRINT NAME
C6-C i 5"LSl 7 7
COUNTY CERTITICATION NUMUR --
State of Florida. County or Al/i/z-r•,v
The foregoing instrument was signed before me this —day of
p/to-c cy k yW
echo is µersomilty known ✓or has producod a
us idcrtNflc Ton.
STAMP
Sign f N tart' ubi
/u
Print Nattu: of Notary Public
S 0 TRACTOR SICNATURU (Qua€iticr)
DULCE B LARA / CM 332346
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed, before me this 31 day of
7/tA&V J& 29!f , by W J eR %` Ov�
who is personalty known „____or has produced a
as ideatiHcation.
STAMP
SS„naturc of Notary n
T�je�es�. J04
Print Name of Notary Public
ti3'Y°� THERESAJAffE
49Notary Public Stela of Florida' • ,��: Notary Public -State of Florida
Ira A. RrIC@ 1,g Commission # GG 202301
Revised tlltrnhOr Tracy "
y� I'FY CommisSiot HH 085816 ~'? oFn�? '= My Comm. Expires Apr i, 2022
¢yF Expires 03/27/2025 Bondod through National Notary Assn.
of.