HomeMy WebLinkAboutchange of plumber subiT ` is n, .
COUNTY
F t U k l p A
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLEASE SELECT ONE OF TEE 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 to 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 rior to
Commencing any work. There is a $50.00 fee for the Change of Contractor. p
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 clone.
Cancellation of permit is to be signed awl notarized by both the owner and qualifier of record. There is no fee foa
cancellation of the permit.
Date: 2- jl lzZ
Permit Number: 2.1 07- nl5,2
Site Address: ,5d O 9 ryla�lid f Q
Ridgeway Plumbing 7
Original GC, subcontractor Or owner/but [der State License SLC License 19-15354
— —
Benjamin Drew's Plumbing & Dram Services In,
New GC, subcontractor' State License CFC1429456 SLC License
Reason for• Cancellation Contract Disputes
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and em !
costs, fees or damacges arising fi•om any and all claims of action for any reason, which may arise as a result of this P coyees from
hange of all
contractor subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
5I_G TURL. 0 �OWN 1-:-(or
fl?'•"ry r�or 9egr+m. me r-
otuurhuilder)
PRINTW Bryan Adams
State of Honda. ('ourlt) 01,5( l.upe CUl.1111
'I he tollnu mg rrutnament %%as acknou ledQed before ine thls
W BryanAdamT,
uho isgarao 4, l.nouo to me
a
ter ho has,has,prod: td s ID �'4
.Signature of %otan. Date
��uu c State or F1pr•da
,C`NrtSrt14�E�Aoore
My Commrsp.on HH 017009
haw Enpires07r01'2024
SIG JATi1RF GF:NF RAL CON TR ACTOR for neu GC. as ttpphc'ahle!
NRINTNAN11_ Benjamin Jimenez
State of F-londa. C'ountl nr St Lucre Cuu111%
'I he rbl owing m ma erit as ackno%%ledge d berore me this
da} of n . 20'LLb)
uho rspersonalh' kr�oun to
meor uno hr,s pr��dc}4ed as ID
--` �- 1t� 3..�BMW
signature or Notary Date
a
llotary public State or Fturde
Hannah E MooreMy Comm:ssgn HH 01?0gyExprres07+0112024
Fevrsed 11 l6.1016
PERMIT# I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Budding & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
BENJAMIN DREW'S PLUMBING & DRAIN SERVICES, INC. have agreed to be
(Company Namerindividual Name)
the PLUMBING _ Sub -contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) (Primary Contracior)
For the project located at F /6✓110 J"t-t
(Project Street Address or Property T•ax ID Z)
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.
?WN-1RACTOR SIGNATURE (Qualifier)
W Bryan Adams
PRINT NANIE
29179
COUNTY CERTIFICATION NU,%fBF.R
State of Florida, Counts of St Lucie
The foregoing instrument was signed before me Ibis f 3 day of
F,Gbnu-z/ . 20 z y W Bryan Adams
who Is ptrtonsilr known ,ck- or has produced a
as itl� i!r[atinn.
Sig' art of ry Public
Priat Name of Natary Public ````� S7,LFy ii�Y*
r� SSEOH W
.s•
z tx+H 106177
is � d°e+0ed lhN°r' • QQ
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STAXIP
SUB-COWRACT $rGNATURE (Qualifer)
PHI�,�lE
29656
COU\Tl CERTIFICATION NEI.IIBF.R
State of Florida, Count) of ST LUCIE
The foregoing instrument ssas signed before me this 1 -5 dal of
who is personally known V�r has produced a
as Identification.
ANGIE PmaoMo
Notaryh �pState of Parlda
Signature of Notar) Public l'+t`�'.'dF Commission d HH 41988
or t�, •` My Comm. Expires Sep 29, 2024
liorded tarough National Notary Assn,
.�e.�l�o
Print Name a titan Fu lie