HomeMy WebLinkAboutChange of Contractor, Plumbing sub PERMIT# 21 09-0353 ISSUE DATE
�, PLANNING & DEVELOPMENT SERVICES
NIMC ,d � _ l Building & Code Compliance Division
•
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
Rudy Rodriguez have agreed to be
(Company Name/Individual Name)
the Plumbing Sub-contractor for Cavalier Plumbing
(Type of Trade) (Primary Contractor)
For the project located at.3110 S 22nd Street Fort Pierce 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
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.
41
rY -
CO CT O SIGNATURE T (l Tier) SUB-CO SIGNATURE(Qualifier)
( y Eric Foster
PRINT NAME PRINT NAME
23197
COUNTYCEItTITICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,Countyof St Lucie '
State of Florida,County of
The foregoing instrument was signed before me this y of The foregoing Instrument was signed before me this 14th day of
20 22,by__1 AQ (� t� February 20�2,by Eric Foster
who is ersonall known_or has roduced a FL DL
P Y p C/ who is personally mown Or has produced a
as identification. as Identification.
co STAMP STAMP
Signature of Notary Public Signature of Notary Public
fL� � / Eric Harrell
`� — Puer�snm a�iorie.
Print Name of Nota Pull 4 G H N Print Name of Notary Public ffC Harre6
a
ELL EN VAU Public MrCommhslonGG913200
;=p•�Y" tate of Florida-Notary f9M 02flW023
M
¢- Commission# GC
2700es
Q
= My Commission®
OF
Revised 11/16/2016
I _
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
COUNTY
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 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
come ing any work. There is a $50.00 fee for the Change of Contractor.
;/ 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: C? Permit Number: C;tl 0q
Site Address:
State License SLC License
Original GC,subcontractor o owner/builder
State License SLC License
New GC,subcontractor r
Reason for Cancellation
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.
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SIGNATURE F O R(or own uildje) IGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME 0 PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St:Lucie County
The following instru ent was acknowledged before me this The following instrument was acknowledged before me this
�ay of"�,2a� day of 20_ by
who is personally known to me who is personally known to
or who has 9du ed ID. me or who has produced as ID.
Signature of Notary -re of Notary Date
ELLEN VAUGHN
`=;PB- eState of Florida-Notary Public
_+ Commission #GG 270079
Revised 04/15/16 o= My Commission Expires
,eOFf 02.
i���` (Datmher 22. 22