HomeMy WebLinkAboutChange of Contractor13217337092 D. R. Horton - Melbourne
21:59:16 12-16-2015 6/11
3
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE AUG 13 2021
FORT PIERCE, FL 34982
772Lugie
462-1553 FAX 462-1578 st. Perm County
PermCounty
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 fled 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_CIIANGE 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: 7128/21
Site Address: 3449 Trinity Cir
Permit Number: 21050823
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
contractor/subcontpactor or, cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNAT GENER O 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 acknowledged before me this
28 day of July 201 by Brian Davidson
personally known who is personally known to me
or who- pfrdrr d ei_— as ID.
!� 7/28/21
Signature of Notary Date
DINAPARRINO
,.
MYCOMMISSION060935043
EXPIRES: Febroary 27, 2024
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EaadMlbruNotary PulkoUndanrritan
The following instrument was acknowledged before me this
se day of J4 20_, by — J+
personally known
who is personally known to
me or,whorlidis pr n'eed�� as ID.
7/28/21
Signature of Notary Date
DINAPARRINO
MY cOMMtSsioN R GG 93W3
EXPIRES: February 27. 2024
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13217337092 D. R. Horton — Melbourne 21:59:40 12-16-2015 7 /11
PERMIT# 21050823 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Mechanical One
(Company Name/Individual Name)
the Plumbing Sub -contractor for
(Type of Trade)
For the project located at 3449 Trinity Cir
D.R.Horton Inc.
(Primary Contractor)
(Project Street Address or Property Tax ID #)
RECEIVED
AUG 13 2021
St. Lucie County
Permitting
have agreed to be
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.
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CONTRACTOR SIGNATURE (Qualifier)
Brian W. Davidson
PRINT NAME
CRC1327068
COUNTY CERTIFICATION NUMBER
State of Florida, County of Brevard
The foregoing instrument was signed before me this -day of
.IDLY .2o2,byBrian W. Davidson
who is personally known—Vor has produced a
as identification.
STAMP
Signature of Notary Public
Dina Parrino
Print Name of Notary Public
DINAFARRINO
MY COMMISSION # GG 935M3
EXPIRES: February 27, 2024
`•`•"?;'' 6wded TbruNotary Pub11, Wdermllers
SUB- TRACT I E r)
Jason James
PRINT NAME
CFC1430061
COUNTY CERTIFICATION NUMBER
State of Florida, County of Brevard
The foregoing instrument was signed before me this 28 day of
JULY 2021 by Jason James
who Is personally (mown Y or has produced a
as identification.
Signature of Notary Public
Dina Parrino
Print Name of Notary Public
v'• DINAPMRINO
MY COMMISSION H GG 935643
;a? EXPIRES; February 27, 2024
Bonded Thru Notary Public UndeWters
STAMP