HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
d 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-15.78
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 Cliange-out). A recorded copy must be submitted prior to
commencing any work. There is a $50.00 fee for the Change of Contractor.
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 PERNOT — 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: C ) 05
Site Address: 3 —I `ck j �-� ►�1 }-� \ �—
Ridgeway Plumbing State License CFC019077 SLC License 30947
Original GC, subcontractor or owner/builder
Mechanical One State License CFC143006i 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 oi_damages arising from, any and all claims of action for any reason, which may arise as a result of this change of
contractor/suiicont Or or cant e6tion,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 BrianDavidson PRINT NAME Jason James
State ofFlorida, County ofSL Lucie County
The following instrument was acknowledged before me this
28 day of July 20 21 by _!Ian Davidson
personally known who is personally known to nre
or w o-h pa rs dy !G as ID.
.7/28/21
Signature of Notary Date
"+" DINAPARRINO
7'A MY COMMISSION#GG9=3
, A,,EXPIRES; February27, 2024
`1 is6oRCodIhNNolaryPubfeUndar*dlers
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
is day of July . 20— by Jnsan A —
personally known who is personally known to
me o�vho i as pr duas ID.
7/28121
Signature of Notary Date
DINA PARRINO
' MY COMMISSION #60 93W3
b EXPIRES: February 27, 2024
qti Banded rtlN Notary Public Undarwdlers
PERMIT-#
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Mechanical One
(Company Natne/Individual Naine)
the Plumbing Sub -contractor for
(Type of Trade)
For the project located at
Jq f R
D.R.Horton Inc.
(P imary Contractor)
(Project Street Address or Property(Tax ID #)
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.
CONTRACTOR SIGNATURE (Qualifier) SUB- RACT,q I E i , r r)
Brian W. Davidson
PRINT NAME
CRC 1327068
COUNTY CERTIFICATION NUMBER
State of Florida, County of Brevard
The foregoing instrument was signed before me this 28 day of
July 2o21, by Brian W. Davidson
who is personally lmown_V_or has produced a
as identificat
ion.
/l/.• e�� �-ri STAMP
Signature of Notary Public
Dina Parrino
Print Name of Notary Public
*+i*'J DINAPARRINO
MY COMMISSION # GG 9W3
EXPIRES; February 27, 2024
'�•`.° };°4' banded7hnrNotary Pub¢cUndenrdters
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 2o21by Jason James
who is personally tmo,rn -Vor has produced a
as tdcnti ication.
Signature of Notary Public
Dina Parrino
Print Name of Notary Public
:a•..y DINAPARRINO
Y. MY COMMISSION # GG 9M3
o EXPIRES; February 27, 2024
BondodituuNotary PublicUnderMtars
STAMP