HomeMy WebLinkAboutChange of ContractorPLANNING & 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 pennit. 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 CHANIGE 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 PERTNUT — 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:
a(o5o13(,o17
Site Address: I l":�
Ridgeway Plumbing State License CFC019077 SLC License 30947
Original GC, subcontractor or ownerlbuilder
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 cancellation of permit. A permit cannot be cancelled if work has been performed.
nSIGNATURE OF OWNER (or oxvner/builder) SIGNAT GENER ON R or n C, as applicable)
PRINT NAME Brian Davidson PRINT NAME Jason James
State of Florida, Comity of SE. Lucie County
The following instrument was acknowledged before me this
28 dayof duly 20 21 by Brian Davidson
personally known who is personally known to me
or o�cei}-7�---was 1D.
7/28/21
Signature of Notary Date
'':�!�""•4 OINAPARRINO
�;; My COMMISSION OGG935643
`•'; EXPIRES: February 17, 2024
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State o£Florida, County of St. Lucie County
The following instrutent was acknowledged before me this
zo day of MY 20_, by d° a°mos
personally known who is personally known to
me or . o i as�noet3�as ID.
r J% 7/28/21
Signature of Notary Date
PARRINO
myCOMMI SION#GG935643
EXPIRES: February27,2024
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PERMIT# d ! 0 50�—s (� 7 ISSUE DATE
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Mechanical One
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
(Company Name/Individual Name)
the Plumbing Sub -contractor for D.R.Horton Inc.
(Type of Trade) 2 /) q
(Primary Contractor)
For the project located at vy I �aC
(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)
Brian W. Davidson
PRINT NAME
CRC1327068
COUNTY CERTIFICATION NUMBER
State of Florian, County of Brevard
The foregoing instrument was signed before me this 28 day of
July 2o2—tby Brian W. Davidson
who is personally Itnown-l—/or has produced a
as identification.
STAMP
Signature of Notary Public
Dina Parrino
Print Name of Notary Public
1t•. DINAPARRINO
`. MY COMMISSION If GG 9WA
= ; A EXPIRES*. Febivary27, 2024
600d(AThalNotary POWUndeWtars
SU TRACT [ E r)
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
July 202`1 /by Jason James
who is personally Imown V or has produced a
as identification.
Signature of Notary Public
Dina Parrino
Print Name of Notary Public
iM:!U''•,DINAPARRINO
, AIYCOMMISSIONUGG935643
Q EXPIRES: February27,2024
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