HomeMy WebLinkAboutChange of ContractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE 1
FORT PIERCE, FL 34982 1
(772) 462-1553 FAX 462-1578
RFC�E®
NAY V 418,
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Changsigneda of Contractor is to be and notarized by property the PertY 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 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 CHANGE OF SUBCONTRACTOR — Subcontractor changes are fo 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.
135°e""C 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: 22, MAY 2018 Permit Number: 170910375
SiteAddress: '13506 NW COCO PLUM CT
AEM & ASSOCIATES LLC.
Original GC, subcontractor or owner/builder
License 30354
State License L' F e ►'l SLC License
New GC, subcontractor
Reason for Cancellation OTHER PLUMBER HAS BEEN REMOVED FOR THE PROJECT
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from
costs, fees or damages arising from any and all claims of action for any reason, whiA may arise asla result of this change of
contractor/subcontractor or cancellation ofpermit. A permit cannot be cancelle tf,work has bee�o#erformed.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_, by
who is personally known to me
or who has produced as ID.
22, MAY 2018
Signature of Notary Date
Revised 04/15/16
PRINT NAME
ANDRE E. M
State of Florida, County
TIM following instrumet
Mday of
me
new GC, as applicable)
Lucie County
acknowledged before me this
20__T-by
who is personally
ally known to
as ID.
22.E MAC
*-of Notary Date
Timothy i
Notary'
State of
�y Commission
CommISslon i
pins 041200
PERMIT # ISSUE DATE
I
PLANNING & DEVELOPMENT SERVICES I
Building & Code Compliance Divisi 19y
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
AEM & ASSOCIATES Ilc
(Company Name/Individual Name)
the PLUMING
have agreed to be
Sub -contractor for MASTER APPLIAREPAIR. INC
(Type of Trade) j (Primary Contractor) %
For the project located at 13506 NW COCO PLUM PALM CITY, FL
(Project Street Address or Property Tax ID #)
It is understood that, if there is any change of status regarding our participation with the above mentioned
I
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.
Z
CO TRACTOR SIGNATURE (Qualifier)
ANDRE E. MICHELE
PRINT NAME
30354
COUNTY CERTIFICATION NUMBER
State of Florida, County of S 4--. Lei'& GO'
The foregoing instrument was signed
�before me this
{ 10day of
20cKf-1 by y`'�
who is personally known _or has produced a I�
CHRISTOPHER OFE�NLOPCH
PRINT NAME
COUNTY CERTIFICATION NUMBER
State of Florida, County of - L"L-��� C m `
The foregoing instrument was signed. before me this day of
20�, by / Yl t ) ti'i%� ( fT� L' A
i
who is personally known or has produced a l
I
as 'denn"cation. as d ratification.
I
STAMP
g nre of Notary Pubh JigIntWurre.17 Notary Public
I
TT �S
Print Name of Notary PublicU Print Name of Notary PublibJ
ttttt..„ LASHANtiA INGRAM
Notary Public - State of Florida
My Comm.,Er,pires Dec ?_0, 2018
Commission �E FF 177249
Revised 11/16/201S'7. i',? •` Bonded through National Notary Assn.
STAMP
U�PR�t�Ue LASHIAHNA INGRAM
!Votary 'ublic - State of Florida
_ My Comm. ";p"es
in 20, 2018�
_ {
!Commission dt FF 177249
t{; Assn.
'%F.... Bonded through t _t,o =! Notary