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................,,,,.,,.;,.,,....... Planning & Development Services
_ Building & Code Regulations Division
2300 Virginia Ave.
- Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Permit
Change of Contractor is to be completed 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,
signature, and transfer fee. A new Notice of Commencement must be filed in the new contractor's
name for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: 1.10.2022 Permit Number: 2109-0481
Site Address: 8204 S Ocean Drive, Jensen Beach
The Plumbing Company of the Treasure Coast
Original General Contractor (or Subcontractor)
State License 2109-0481-03 SLC License 20127
Master Plumbing State License SLC License 27366
New General Contractor (or Subcontractor)
Reason for Change Not able to do the job
The undersigned does hereby agree to indemnify and hold harmless St. Lucie County, its officers,
agents, and employees from all costs, fees, or damages arising from any and all claims of action for
any reason, which may arise as a result of this change of contractor/subcontractor or cancellation of
permit. A permit cannot be cancelled if work has been performed.
AIGNATURE OF OWNER (or owner/builder
PRINT NAME
State of Florida, County of St. Lucie County
The following i ument was ack�no/wle e beforhis
11day of
who is personally know to me
has produced /J as ID.
FRANCES DONUT
EqPE3 J9lWj&J7fo change of
,d 7hru Notary Public Underwriters
* SIGNATURE OFF/W GENERAL/NT TO
PRINT NAM
State of Florida, ounty of St. Lucie County
following trument was acknnoledge fore fine this
y 20 wby �/
who is per onally know to me
or who has oduced as ID.
Signature o FFpp��NCES DONZA
Btu'$'' •'�'•; D9TC'
UY COMMISSION # HH 111471
EXPIRES: JUiy 27, 2025
subcontrac DFJ FCg" Bonded Thru Notary Public Underwriters
the
PERMIT # a j� y r% / ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
(Co
k//Individual T�(ayne)
Sub -contractor for
(Typ of Trade)
For the project located at efcz Y S
(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 SIG ATU (Qualifier)
�I
P NAME
W -, / 6_o4
COUNTY CERTIFICATION.JNUMBEP,
State of Florida, County of
T e foregoing instrument was sig d before me this ay of
"2�l li by ,�rl
o is navy known or has produced s
as
PRINT NAME
Zy 3 �� GAG Z s 7
COUNTY CERTIFICATION INUMBER
State of Florida, County o
The regoing instr �est wasign before me this day of
,2 ,by
lerson.11y known or has produced a
as
FtDONZA
of Notary u is _ MY COMMISSION # HH 111471 Si
EXPIRES: July 27, 2025
Bonded Thru Notary Public Underwriters
ie of Nat0i Pub. s
Revised 11/16/2016
ur! of Notary Public
Name of Notary Public
*, MMISSItCj#P(}I"111471
:r;
. bW EXPIRES: July 27, 2025
''l F�°�''• Bonded Thru Notary Public Underwriters