HomeMy WebLinkAboutChange of Sub-Contractor (Plumber) �I q
PERMIT# \(� l 1 0 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
•
II . . . . �. ^•. BUILDING PERMIT E���.,E��e
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SUB-CONTRACTOR AGREEMENT
JUL 2 9 202i
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 — OlaoIMG—Q- 2
(Project Street Address or Property Tar M#)
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 TRACTP I E t r)
Brian W. Davidson Jason James
PRINT NAME PRINT NAME
CRC1327068 CFC1430061
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of Breyard State of Florida,County of Brevard
The foregoing instrument was signed before me this 28 day ar The foregoing instrument was signed before me this 28 day of
July ,a2:LbyBrian W. Davidson July 2021 by Jason James
who is personally known-v—or has produced a who is•personally*u Gwn_v or Ims produced a
as identification. _ as identification.
a r � STAMP �l/ STAMP
Signature of Notary Public Signature of Notary Public
Dina Parrino Dina Parrino
Print Name of Notary Public Print Name of Notary Public
DINAPARRINO %nY'r,'q DINAPARRINO
MY COMMISSION#GG 935643 ,. MY COMMISSION 9 GG 935M3
=� S February 27,2024 a,' IX February EXPIRES;Februa 27,2024
EXPIRES:fe :, aT
tSonded7hruNotaryPubEcUndemdters tiondod7hruNataryPubgrUadaWler3
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PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE R�CEruED
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 JUL 2021
ST, t ucie County,Pel mitting
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. .
_ X 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 pennit is to be signed and notarized by both the owner and qualifier of record. There is no.fee for
cancellation of the permit.
7/28121 i 6 U 1
Date: Q ` Permit Number: L4 I
Site Address: t i L
Ridgeway Plumbing State License CFC019077 SLC License 30947
Original GC,subcontractor or owner/builder
Mechanical One CFC1430061 32493
State License SLC License
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 ctor or cancellation of permit.A permit cannot be cancelled if work has been performed.
r�
SIGNATURE OF OWNER(or owner/builder) SIGNAT GENE ON—rRACMaR or a C,as applicable)
Brian Davidson Jason James
PRINT NAME PRINT NAME
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 2_�by Brian Davidson 4B day of .my 20_,by J-1—
personally known who is personally(mown to me personally known who is personally known to
orw e'( / �� as ID. me5�ti duccd� as ID.
7/28121 �� a 7/28/21
Signature of Notary Date Signature of Notary Date
+yNt�ui , DINAPPtiRINO +%L OINAPARRINO
MY G0MMlSS104 p GG 935t}t3 _ my COM)AISSION N GG 935643
EXPIRES:February 27,2024 '•{ e EXPIRES:February 27,2024
6ondodThruNoteryPubrnOideiwdters '.?e,•;:�°` Banded 7hNtiotaryi'ubleUndanriten
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