HomeMy WebLinkAboutChange of Sub-Contractor (Plumber) (o
PERMIT# �l O C i�`Q(� ISSUE DATE
t `'l V-1 -1
PLANNING & DEVELOPMENT SERVICIE& -- ' _ ..
RAC
Building & Code Compliance Divis n
BUILDING PERIMIT
JUL 2 9
SUB-CONTRACTOR AGREEMENT Lucie County,RE`1Trf_rrir !
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_ l y O�d Y3' Q. 'D 0
(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- TRACT) 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,byBrian W. Davidson July ,2021 by Jason James .
who Ispersonally k nown,/or has produced a who is persou `
alIy known �!or has produced a
as identification. as identification.
STAMP �G/�+ � �i rw" STANIP
Signature of Notary Public Signature of Notary Public
Dina Parrino Dina Parrino
Print Name of Notary Public Print Name of Notary Public
ty DINAPARRINO �hVIV OINAPARRINO
MY COMMISSION li GG 935643 MY COMMISSION f�CSG 935643
EXPIRES;February 27,2024 EXPIRES:February27,2024
fO ` 6endodThru Notary Public Underwdters F,ondodfinrNotaryPab——de nnllers
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... �...... : z;Y_ .� PLANNING & DEVELOPMENT SERVICES
w BUILDING& ZONING DIVISION RECEIVE►
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 J U L 2 9 2021
(772) 462-1553 FAX 462-1578 sT. Lucie County, Permitting
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERW
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.
__�L_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 PER HT—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: 2 t U`t 09 1
Site Address: qq61
I d �1M G C
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
contractortsubcontpactor or gancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNAT GENER ON R or n 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 acknowledged before me this The following instrument was acknowledged before me this
28 day of July 20 21 by sb Brian Davidson Ia day of J 20_.,by Li-1a 1
personally known _who is personally known to me personally known who is personally known to
or o rod o�� as ID. me or o-lta`s�r u'cd , as 1D.
!ram, 0 7/28/21 7/28/21
Signature of Notary Date Signature of Notary Date
+/'%g''• DINAPARRiNO "KY�'"•,_ OINAPARRINO
MY COMMISSION#GG 93SM3 '
:? MY COMMISSION#GG 935643
pp> EXPIRES:February 27,202� P: EXPIRES:February 27,2024
5ondodThruNaIMP&EoUndanMl:rs 6cn�edThtuNe1aryPub6cUn4ennihr3