HomeMy WebLinkAboutChange of sub/ sub agreement 13217337092 D.R.Horton—Melbourne 23:44:57 12-16-2015 6/9
__ :...:. ..... ...m:..:_,.,. PLANNING&DEVELOPMENT SERVICES RECEIVED
e BUILDING&ZONING DIVISION
_ 2300 VIRGINIA AVE AUG 13 2021
FORT PIERCE,FL 34982 St.Ludo County
(772)462-1553 FAX 462-1578 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.
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 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: 8/13/21 Permit Number: 21040948
Site Address: 9511 Potomac Dr
Ridgeway Plumbing State License CFCo19077 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/subc�ctor or ancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNA GENE ON or n ,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
13 day of AUGUST 20 21 ,by Brian Davidson 13 day of AUGUST ,20 ,by Jason_-
personally known who is personally known to me personally known who is personally known to
orwjto as ID meoryd�to �produced�����aslD.
8/13/21
Signature of Notary Date Signature of Notary Date
u<+�" DINAPARRINO :*tti'• DINAPARRINO
MY COMMISSION N GG 93*13 '� fit'•
.. MY COMMISSION q GG935643
EXPIRES:February 21,2024 A E(PIRESFebtuary2T,2024
•over r.0�•o Wndad ThaNalary PuBta Undarvrdhn roD dod ThNNAWPW Ur&r014m
13217337092 D.R.Horton—Melbourne 23:45:33 12-16-2015 7/9
PERMIT# 21040948 ISSUE DATE
:. :•>,_,:> ,,. .,..;.;,r�.,_, :.;�;,: ^,:;,, PLANNING&DEVELOPMENT SERVICES q�0ty�
Building &Code Compliance Division
AUG 13 2021
BUILDING PERMTI
SUB-CONTRACTOR AGREEMENT �i.Lucie tingrsty
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 9511 Potomac Dr
(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_ y day of The foregoing instrument was signed before me this 13 day of
August .202j,byBrian W. Davidson August ,2021 by Jason James
who is personally Inown_Vor has produced a who is personally known�_Vor has produced a
as identification. as identification.
STAMP STAMP
Signature of Notary Public Signature of Notary Public
Dina Parrno Dina Parrino
Print Name of Notary Public Print Name of Notary Public
DINAPARRINO iO.VF,N. DINAPARRINO
MY COMMISSION#039=3 ' ;= MYCOMMISSION900935W
='rp,•` EXPIRES:February 27,2024 ;,r, eA EXPIRES:February 27,2024
''•.eei:°••' Bonded ThN Notary PublirUndenmlers `�°F';°' Bonded ThN Notary Public Undarkitan