HomeMy WebLinkAboutChange of Sub-Contractor (Plumber) o
PERMlT# O� O t � � ISSUE DATE
yrT:b <�Qyc PLANNING &DEVELOPMENT SERVICES
Building & Code Compliance Division
. R15-Cv=IVisa
BUILDING PERMIT
SUE-CONTRACTOR AGREEMENT J U L 2 'H211
2
ST. Lucie County, Permitting
Mechanical One have agreed to be
(Company Name/Individual Name)
the Plumbing Sub-contractor for D.R.Horton Inc.
(Type of Trade) (Primary Contractor)
For the project located at 3 3 , q go M-e—'s 2
(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) SU TRACT�CI 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 Brevard 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 2021,by Brian W. Davidson July z921 by Jason James
who is personally known_Vor has produced a who is personally Imown Vor has produced a
as identification. as identification.
------------
STAMP STAMP
Signature of Notary Public Signature of Notary Public
Dina Parrino Dina Pardno
Print Name of Notary Public Print Name of Notary Public
r}ir{u DINAPARRINO ri_rYri'"•. DINAPARRINO
' ` MY COMMtSSION l«GG 935CA3 MY COWSSION N GG 9M3
EXPIRES:February27,2024 ':re,i EXPIRES:February27,2024
FOp.:,`,°� Goaded Thou Notary Pu4Gc UndenMfets �ej ''' bonded 1bN Notary PubnaUnd.11Mt.s
8
at;c V;"r3 =r7 PLANNING & DEVELOPMENT SERVICES
BUILDING& ZONING DIVISION =ECET ,2300 VIRGINIA AVEFORT 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 wifh 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 Sub-
Contractor.
CANCELLATION OF PERMT—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: 7128121 Permit Number: 0 R E) S
Site Address: 3 3 i �. �!6+n-eS"t��-c� 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
coritractor/subcont ctor or cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNAT GENER ON R orn C,as applicable)
PRINT NAME Brian Davidson PRINT NAME Jason James
State of Florida,County of St,Lucie County State of Florida,County of St.Lucie County
The following instrument was ackmowledged before me this The following instrument was acknowledged before me this
28 day of duly 20 z� by Brian Davidson 20 clay of, Joy 20_,by Jame Jamas
personally known —who is.personally known to me Personally known who is personally known to
or N o-h prod ce l�� a ID. me or as pr necd� as ID.
7/28121 i' 7/28I21
Signature of Notary Date Signature of Notary Date
t:'• DINAPARRINO ;i*;y•, DINAPARRINO
` h1YC0ASNISS10NtFGG835643 '� MYcO1duISSIONgGG935643
EXPIRES:February 27;2024 EXPIRES:February 27.2024
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