HomeMy WebLinkAboutChange of ContractorC FO(UJ N T Y
F L 0 R I D A
L
PLANNING
ING & DEVELOPAWNT -SERVICES
Building & Cock C61000;0 01"ISIOn
:COMMERCIAL: PLUMBING INC
- BUILDING` PERMIT
SUB -CONTRACTOR AGREEMENT!
agreed to be
(Company Name/Individual Name)
sub-Contrae
the. PLUMBING CONTRACTOR tor for STANS.ELL PROPERTIESA DEVELOPMENT
(Type of Trade) (Pri,;ary. ZWntract6r)
For the.project located at, 4878 N KINGS HWY, FT PIERCE
(project Street Address or PropertyTax.[D
It is, understood that; if there is any change of status regarding. our participation with the above: mentiobed.
Project, the . Building and Code Regulation Division of St Lucie Coutity will be advised pursuant to the
Ming of a Change . of &40-oohttactbr. notice.
1.
ZUR SIGNATURE (QdMer)
T&CTOR
PRINT' NAME
1 15qv
COUNTYCERTIFICATION NUMBER,
Stateof Florida, County 4"'Iec/
The f6rcgofug instruragat was signed before me this 16' day of
by S4eaZ
who is personally known Ae r has produced a
LES TER J CRAWFORD III
PRINT NAM
P07000022212 / CFC-057540
COUNTY CEIMFICATIONNUMBER
State of Florida; County of $T LUQIE
The foistH
regoing instrutnint was signeil before me this day of
JUNE LESTER J CM. WFORD III
20__,:by_
who is personally known orhasproduceda.
as 1d "ration: as Identifleation.
STAMPSTAMP
signiture of NotaryPt c oha I
Ke �RENEE, ABATALINI
Print NPvnc'ofNotary ,Public PrintWelme of Notary Mite
-
J�EILER
-E NGoMMISSI# GG943721EExpIresFebruarAD2J24 I "oUTAI
W4 N*ayPbk.. Stile of Florida'BondedTruTrOYFa1.1nW.mWW70i9 )kW0y F*r" Feb 24, 2024
Revised I I/W2616 B00ld
through Havoul "Mary sm,
PLANNING & DEVELOPMENT SERVICES
BUILDING. & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 4b24553 FAX 4624578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OFTHE FOLLOWING:
CHANGEOF.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 $2,5.00 ($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 ChangeofContractor,.
_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-
Contractor;
_. 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:. to-15-P-011A Permit Number: LC , Q 3 9 3
Site. Address:
�L enn4 5 i� PtuLvlk6t ..State L-icenseCPV-'1gaS5q,1. SLCLicense
Original GC, subcontractor or :owner/buil
C.Orn MAP k0_t ctl -T-nG State License OFC 0515 40: SL_ C License 2 Z 2 tZ. .
New GC; subcontractor
Reason for Cancellation
Theundersigned.does hereby agree to indemnify and hold harmless St Lucie County, its officers,zgents and employees from all
costs, fees. of 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 perrdit cannot ca "celled &w rkhas been performed.
SIGNATURE:OF OWNER (or oarner/builder) SIGXATLJRE GENERAL CO CTOR (ornew.GC, as applicable),
PRINT NAME PRINT NAME
State of Florida, County of St: Lucie County
The following instrument was acknowledged before me this
day of ,20_, by -
who is personally known to me
or who has produced . ... :as ID.
Signature of Notary Date
Revised 04l15j'E
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_Ls day of '.J�-tRQ 20 Zr, by .�" ,i - .54-e5Q
who peisanally know�to
me r w yo has produced.. iD.
yes
-l5'zoZ/
Signature of N. ot-ry . Date
.... MANAJ.KEIIE,R
Commission # GG 943721
�p`Expires February 10, 2024
ko�t�4• BondedTNUTtayfamtowrance500-3657019