HomeMy WebLinkAboutupdate to plumbing subSAT.,
COUNTY
F t U k I D A 46
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLEASE SELECT ONE OF THE FOLLOLVtNG:
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 fled in the new contractor's name
for job values greater than $2,500 ($7,500 if A/C Change -out). A recorded cop) 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 rbcontractor rrtlrst fill out a Subcontractor Agreement
Contractor. Form. There is a $50.00 fee for the Change of Sub -
CANCELLATION OF PERMIT -- The cancellation of permit is acceptable only ifno 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 fol-
cancellation of the permit.
Date: 21 1-0lZ
Permit Number:
Site Address:
Ridgeway Plumbing
Original GC, subcontractor or owner/builder
Benjamin Drew's Plumbing & Drain Services Inc
New GC. subcontractor
Reason for Cancellation Contract Disputes
G
LGI
State License SI.0 License 19-15354
State License CFC1429456 SLC License
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 front and 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.
FGNATUREOFO1�L'N1i�Rj o
PRInT rrA,%fZ W. Bryan Adams
.51atc of Florida. C'otnt(} of S1 t.ucic Count%
The 1b1loui119 1115lntInent %tat- ackr10%%Wacd betbre ine this
dot or id Ity W Bryan Aeams
,rho is ersonartc knu++n to me
p--
t r hu IS rode ed ai 10
.Signature of Nutan' Date
ami1 Flprrtltr
Oiioes
SJUNA IURF G1 N( RAI C'Ov"rRACr ()R for rteu CC. as appt.r�th e
r'RINT NAN117. Benjamin Jimenez
Stitt! or Florida. ('iainq or St Lucie Couru�
The i 11oain9 nt Rritlent uas acknonlcdged before me this
dad ni '-U,
uho is rsnnall, nau to
(UMipost ced as ID
Signature of Notan Date
�J� E''e'',''to of FLprIda
anah EMoore•� y CrrlmiSSW HH 017099
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PMMIT # ISSUE px
CUu NT,Y,.,L Ai
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
BENJAMIN DREW S PLUMBING & DRAIN SERVICES, INC. have agreed to be
(Company Naatellndividual Name)
the PLUMBING Sub -contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) (Primary Coniraclor)
For the project located at _L" (' "
(Project Street Address or Property Tax ID 9)
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.
RACrOR SIGNATURE (Qaalitkr)
W Bryan Adams
PRINT NAME
29179
COU " f CERTiF I_CAT IOiSO*Ilk R
stale of Florida, Coast) of St Lucie
The foreping iaslran no wos sigped iefnrr use tkis day of
j i,t,ar iZ� W. Bryan Adams
wbo is peesosolly knows X—or has peodored a _ _ .
�WASIA�'%
SUB-COYTRA CN[ATURE (Qualifier)
2906
conll CERTIFiCAT1O'% NUMBER
Slate of Aarids, Count) of ST LUCIE
The foreong imerameoi on siEQne�d before me ibis day of
of 1L tYtit'l . ncle Y1C
wbs is personally known zor hue produced a
as kfesWkation.
�iiANWEPERDOAO
Notary6State of Florida
Lary public Commission N HH 47988
Wn,. My Comm. Expires Sep 29, 2024
Banded through National Notary Assn,