HomeMy WebLinkAboutChange of sub/ sub agreement 13217337092 D.R.Horton—Melbourne 23:44:22 12-16-2015 4/9
PLANNING&DEVELOPMENT SERVICES ASCF-IvEI)
S BUILDING&ZONING DIVISION
- 2300 VIRGINIA AVE AUG 13 2021
FORT PIERCE, FL 34982 St.Lucie 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— of Contractor is to be signed and notarized b the r Change gn y 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: 21040978
Site Address: 9413 Potomac Dr
Ridgeway Plumbinn 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 ctor or ancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(orowner/builder) SIGNAT GENER ON R orne ,asapplicable)
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
13 day of AUGUST 2021 by Brian Davidson .13 day of AUGUST 20 ,by J•...J =•
personally known who is personally known to me personally known who is personally known to
or who h pa r eif�� as 1D. the or ytho h ppm'du'c� as ID.
�., �r1 u•.0 8/13/21 8/13/21
Signature of Notary Date Signature of Notary Date
�*t�"'•4 OINAPARRINO '✓u;'•. DINAPARRINO
MY COMMISSION#GG OW3 �'
,t MYcOMMISSI0N9GG93rA3
P EXPIRES:February 27,2024 EXPIRES:February 27,2024
bonded ThN Notary P&z Undemiteni •fPi!;g•: 6onded ThNNolary PLMUndaWI,n
13217337092 D.R.Horton—Melbourne 23:44:42 12-16-2015 5/9
PERMIT# 21040978 ISSUE DATE
:.:.. ::.............:.: .. .: ..:.: F:::. PLANNING &DEVELOPMENT SERVICES RECEIVED
Building & Code Compliance Division AUG 13 2021
BUILDING PERMIT St.Lucie County
SUB-CONTRACTOR AGREEMENT 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 9413 Potomac Dr
l?
(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 i 1 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__1_3 day of The foregoing instrument was signed before me this 13 day of
August ,2021,by Brian W. Davidson August ,2o2`1 by Jason James
who is personally known—Vor has produced a who is personally known V/or has produced a
as identification. as identification.
STAMP STAMP
Signature of Notary Public Signature of Notary Public
Dina Parrino Dina Parrino
Print Name of Notary Public Print Name of Notary Public
DINAPARRINO ;�y>" DINAPARRINO
MY COMMISSION 9 GG 93W3 MY COMMISSION IGG 935643
or EXPIRES:February27,2024 ;� P EXPIRES:FehNary27,1024
handed Tluu Notary Publk Underwdters Sonded 7hru Notary Public Underwriters