HomeMy WebLinkAboutChange of Sub-Contractor - Plumbingter- -
COU NT Y '"
F L O R I D A
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
lumblylO1 W(DVACz:,
Compan Name/Individual Name) J
the Yl Sub -contractor for
(Tye of Trade)
For the project located at 7872 Saddlebrook
INC
have agreed to be
A Great Home, LLC
(Primary Contractor)
(Projcci Sircet 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 Sub -contractor not
SIGNATURE
DARRICK BAI
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida. County or ST LUCIE
The foregoing instrument was signed before me this 110 day of
JUNE .20Aby Darrick Bailey
who Is personally known ur has produced a
aK Went if>cal[on. T�
6tgnature Nat rAMP
4i"''•` CRYSTAL Y BISHOP
Prt IfIga otlgE(i 1Y,rta MISSICN 4 GG 127618
:+r
OWF EXPIRES July 24. 2021
ReViaed 11/1612k)16
SUB•CON'I'RACTOR SI(iNATURE (Qualifier)
PRINT NAME.
COUNTY CERTIFICATION NUMBER
State of Florida, County of J+.L_U-C e
The foregoing Instrument was signed before me this —L-Iday of
1 i f� Ire 2U'�? by J�V C! o, rw
-ho IS Dersonaliv [u�own or has produced a
as identification.
7 'i
1
Signature of Notary Public
7
Print Name of Notary public
iiiRro4',. BRENDA:DECARA
k:' Notary Pttblk •daCommissionMy Comm. Exp23Bonded through natissn.
COUNTY
P L 0 R 1 D A
PLANNING & 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 Cormnencement 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
comtr ncing any work. There is a $50.00 fee for the Change of Contractor.
� 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 pen -nit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: (' I 1 Permit Number: � � � � o id � �-
Site Address: T Z add i e �fo a �. D 9. we- , PS L . 1:7 1, 649 V Cc�_
_!"'11 w_a 1 TeG�n P l ismb 1 nq State License SLC License
Original GC, subcontractor or owner'build nn 1
P l lJ rnb t vi W0 4-S I k)C. State License G FC Id 251 JILC License C FV WZ"1
New GC, 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
contractor
'�ubcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SiGNTATURE OF OIX'NER (or owner/builder) SIGNA NERAL C or new GC, as_{applicable )
PRINT NAND `�a1r 1L,C. Sp� n PRINT NAME �PtV k' p G� L� L 1r-1
State of Florida, County of St. Lucie County State of Florida, Count} of St. Lucie County
The following instrument was aclmowledged before mte this
day of11"14K 120 Z r , by-
R, v, d ,5r""- I i > mil who ito me
or who has produced as ID.
"tt�.WZ21
Signature of Nota l- Date
.• ,pY P(j'q 5RENDA R. 4ECARA
Revi ` ,0 =�'tary Puh.ic � State of Florida
Commission # GG 310775
?oF My Comm. Expires Jul 1, 2023
Bonded through National Notary Assn.
The following instrument Wes acknowledged before ine this
;L' day of June , 2021,by
iV�d-�G i 1 fi �'ho is nersona3knaun_ to
me or who has roduced as ID-
Signature of Notary Date
Y A� BRENDA R. Dc'CARA
{' = Notary Pubk - Bute of Florida
�- Commission ; GG 310775
aatti° My Comm. Expires Jul i, 2023
Bonded through National Notary Assn.