HomeMy WebLinkAboutChange of Sub-Contractor (Plumber) I $
PERMIT# �1/� �(�Or\ ISSUE DATE � �1
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...::..._._.. PLANNING&DEVELOPMENT SERVICES
Building & Code Compliance Division =CountV,/Peormitting
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BUILDING PERMIT SUB-CONTRACTOR AGREEMENT
Mechanical One have agreed to be
(Company Name/Individual Name)
the Plumbing Sub-contractorfor D.R.Horton Inc.
(Type of Trade) 9�0
( (Primary Contractor)
For the project located at 1 �� 01y\O..0 r'-
(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.
CONTRACTOR SIGNATURE(Qualifier) SUB- RACT I E r)
Brian W. Davidson Jason James
PRINT NAME PRINT NAME
CRC1327068 CFC1430061
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of 8 revard State of Florida,County of Brevard
The foregoing instrument was signed before me this 28 day of The foregoing instrument was signed before me this 28 day of
July YO2y by Brian W. Davidson July zo2`1by Jason James
Who is personally Imown� /
or has produced a who is personally known V or has produced a
as identification, as idcatifieation.
STAMP STAMP
Signature of Notary Public Signature of Notary Public
Dina Parrino Dina Parrino
Print Name of Notary Public Print Name of Notary Public
ih".fug_ DINAPARRINO DINAPARRINO
MY COMMISSION#GG 935643 = MY COMMISSION#GO 935643
EXPIRES:February 27,2024 cQ';i EXPIRES:February 27,2Q24
6ondod Thru Notary PubGe Underwdters f",F°•'' Banded nru Notary Public Underwrilero
r�
_ PLANNING&DEVELOPMENT SERVICE 4 RECEI Y���`` ---- ---
%f"•.aS'S-�•i^`-r�%iriC'.z?-%�."9�3}'
lJ' J - BUILDING & ZONING DIVISION
2300 VIRGINIA AVE JUL 2 9 2021
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 ST. Lucie County, permitting
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.
_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 Snb-
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: 7/28/21 Permit Number:
Site Address: l Ll 09 �o t D y,-I OTC. (2
Ridgeway Plumbing State License CFC019077 SLC License 30947
Original GC,subcontractor or owner/builder
Mechanical One State License CFC1430061 SLC License 32493
New GC,subcontractor
Reason for Cancellation Vendor Change '
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/subcont etor or cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) siriN7KE GENE ON R or n C, ss applicable)
PRINT NAME Brian Davidson PRINTNAME Jason James
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
28 dayof July 20 21 by Brian Davidson 28 day of Jury 20,_,by Jes—-
personally known who is personally known to me personally known who is personally known to
or w o-ha rs o e �as ID. me or ..wht as cd� as ID.
�„�� �l�y,� 7/28121 i U 7/28121
Signature of Notary Date Signature of Notary- Date
DINAPARRINO ^ :%U•, DINAPARRINO
MY COMMISSION 9 GG 935643 =e? '
' MY COMMISSION 11 GG 935643
e? EXPIRES:February 27,2024 A= EXPIRES'Febmary 27,2024
Sonde4ThmNotaryPubC�,Underwdter3 UndedThtu Notary PubUGUedormitan