HomeMy WebLinkAboutChange of Contractor..... ... ..... r,...�x,� PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
• 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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 pen -nit 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.
TX_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: 71.28/21
Site Address: IJ J (4 1 T�t t
Permit Number:
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/subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNAT GENER9teCON 1 R,4 R orb C, as applicable)
PRINT NAME Brian Davidson PRINT NAME Jason James
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
28 day of July 20 2� , by Brlan Davidson
personally known who is personally known to
orwho•ha prod roe'ti-� is ID.
141-- , 0 7/28/21
Signature or Notary Date
DINAPARRINO
MYCOMMISSIO #GG93W3
�o EXPIRES: February 17, 2024
����!,�,`.°•'• 6oncbdThcutbL�ryAuhCaUndeard:eu
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
28 tJay of J4 20— by Jnam Jamas
personally known who is personally known to
me/who- a} st p uecclf�as ID.
7/28/21
Signature of Notary Date
i+t�' •. DINAPARRINO
` MY COMMISSION I GG 93W3
EXPIRES: February 27, 2024
`�4•`.r.::°•'' 60ndedlhcuNaL�ryPuEL•cUndecxtit�ts
PERMIT # �.Io5ouo
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
331-19 _TRl+ri�
D.R.Horton Inc.
(PriTContractor)
(Project Street Address or Property Tke 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- RACT9 E t .l r)
Brian W. Davidson
PRINT NAME
CRC1327068
COUNTY CERTIFICATION NUMBER
State of Florida, County of Brevard
Jason James
PRINT NAME
CFC 1430061
COUNTY CERTIFICATION NUMBER
State of Florida, County of Brevard
The foregoing instrument was signed before me this 28 day of The foregoing instrument was signed before me this 2$ day of
July 2021 by Brian Wavtdsor _ :-_. ruly zp1 I Jeson James ✓,; ro
who is personally luiown—Vor has produced a who is personally imown �or has produced a
as identification.
Signature of Notary Public
Dina Parrino
Print Name of Notary Public
as identification.
STAMP
Signature of Notary Public
Dina Pardno
Print Name of Notary Public
DINAPARRiNO : ,*u+tp; DINAPARRINO
MY COMMISSION # GG 935643 MY COMMISSION # GG 9 6643
EXPIRES; February 27, 2024 '; � P EXPIRES: February 27,202
` 6ondO Thrallotary Publle Underwdtars `• ' 6ondod 1bru Nota.1-11eUndetwdters
STAMP