HomeMy WebLinkAboutGarry Change of SubcontractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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 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 $2,500 ($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.
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 $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: 6/16/2021 Permit Number: 2105-0083
SiteAddress: 1208 NW Winters Creek Rd. Palm City, F1.34990
Pipe Connection
Original GC, subcontractor or owner/builder
Aqua Dimensions
New GC, subcontractor
License CFC033824 SLC License 26311
License CFC057526 SLC License 18628
Reason for Cancellation Original permit was applied for incorrectly
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
cone cjor/s4contractor or cancellation of permit. A permit cannot bye q11#11ed if work has been performed.
OWNER (or owner/builder)
PRINT NAME Ed Gribben
State of Florida, County of St. Lucie County
The following instrument was acknowledged before
_Hay of r-- 20��, by
r who pr aced
ignature of Notary
Revised 04/15/16
as ID.
6/16/2021
Date
s
s
SIGNATURE GENERAL CONTRACTOR (or new GC,
applicably
PRuvTNAME Ed Gribben
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_
3 s o
State of Florida, County of St. Lucie County
t c
instrument was acknowledged before me t
oLU00 �ao�
g m
�Tlhe}f�ollowing
�,e, , , day of .SSws' 20. by
o
o
��°� ZPIJ who i personally kcno
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a or wh has produc as ID.
6/16/2021
Signature of Notary Date
'
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
MmEmm-
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Aqua Dimensions Robert Ludlum
(Company Name/Individual Name)
the Plumbing
(Type of Trade)
have agreed to be
Sub -contractor for Dreammaker Bath and Kitchen
(Primary Contractor)
For the project located at 1208 NW Winters Creek Rd. Palm City, Fl. 34990 / 4423-701-0009-000-6
(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 Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
ONWtACTOR SIGNATURE (Qualifier)
a 0 =
WA_lamz\y ii�]
awor'.
COUNTY CERTIFICATION NUMBER
State of Florida, County of Martin
The foregoing instrument was signed before we this 16th day of
June 202/ by Ed Gribben
whopersonally knows or has produced a
as identification.
a
DAVED.MORE71
21'APublic- ConTtisslon # HH 10877slrAmp
Sinatureof Notary Public EXOM May$, =5
Dave Morelli 'i�KW 8mMllsuTmyF*Wwm.W.U5.7G19
Print Name of Notary Public
/SUB -CONTRACTOR SIGNATURE (Qualifier)
L
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of
The foregoing instrument was signed before me this day of
20_-�21 by
who Is personally known for has produced a
as identification.
STAMT
Signature of Notary Public U U
C'
Print Name of Notary Public
.iCarj is11, K' � U
horda Lafferty
.1y Cocimisstori HH 094211
Expires 02/1712025
Revised 11116t2016