HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
.` BUILDING & ZONING DIVISION
° 2300 VIRGINIA AVE
1101MIUM M__1i -
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 Cliange-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: 7128121
Permit Number:
Site Address:
2-10 6&Z1
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 ihjs chaapge of
contractor•/subcont ctor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owrter/buiIder) SIGNAT GENE ON R or n 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 21 by Brian Davidson
personally known who is personally known to me
orwho.ha prod a -�- 1 as ID.
'i,_
Signature of Notary Date
;4kvi�%+ ,. OINAPARRINO
MYCOMNISSION#GG935643
MRES; February 27, 2024
••g`r.:' Bonded ThruNotaryPubkUnderwrltera
State of Florida, Countyof St, Lucie County
The following instrument was acknowledged before me this
m day of July . 20_, by L— Jamoa
personally known who is personally known to
me or hell as pr uec l as ID.
7/28121
Signature 'of�Notary Date
DINAPARRINO
` MY COMMISSION N GG 936643
' f EXPIRES: February 27, 2024
Bonded ThruNorsryPuKe,Un&mitam
PERMIT #
% O r1 (
ISSUE DATE
_`yam,,.-'1�� ....
• J
Mechanical One
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
(Company Name/Individual Name)
Plumbing
(Type of Trade)
For the project located at. j qi c
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Sub -contractor for D.R.Horton Inc.
(Project Street Address or
(Primary Contractor)
a( 12.
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- TRACT I E t 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 2o2lbyBrian W. Davidson _
who is personally known- \/or has produced a
as identification.
Signatetrc of Notary Public
Dina Parrino
Print Name of Notary Public
DINAPARRINO
MY COMMISSION # GG 935643
EXPIRES: February 27 2024
Sonded7hru Notary PubllcUnderWhrs
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 - .2o2 1 Jasori Jarrtes. _ ' =�
b y...:
who is personally known'or has produced a
as identirecation.
STAMP
Signature of Notary Public
Dina Parrino
Print Name of Notary Public
oK,+r`•.. DINAPARRINO
MY COMMISSION # GG 93SM3
"fP EXPIRES: February 27, 2024
Sondod?hru Notary Publlc Underwdlars
STAMP