HomeMy WebLinkAboutChange of sub-electricCT u Ivry
f t U k 1 D A
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLEASE SELECT ONE OF THE FOLLQWING:
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 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 to be completed by the general contract tr.
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 — i he cancellation of a permit is acceptable only i f 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: _ r� i ;� f
Permit Number: U gDD
Site Address: eLi-
Ridgeway Plumbing ---- —
Original GC, subcontractor or owner/builder State License Si,(' License 19.15354 —
Benjamin Drew's Plumbing R Drain Services Inc.
New GC. subcontractor State License CFC1429456 SLC License
Reason for Cancellation Contract Disputes
The rindersiggned 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
Zcontractorlsubcontractor or cancellation of permit A permit cannot be cancelled if work has been performed.
SIGN.,-iiTtjREi.:0:rCkWNERcr) C.T. +:Yano':=i5tics 01 o+or
PRiUT W. Bryan Adams
State of Honda. Count) of $t Lucie Count%
The lollotung utsinunent %%as acktim0edeed before tnc this
Ida) or 20ts, w Bryan Ada^s
%%ho is psrsottallt hnottn la me
t$rho has rod ed as ID �4
y.Sig snature of %otary Date
qf c_re a Farr da
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Moore
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My COmmitt6ron HH Ot 7oe9
Expires OP011202a
SIGNATURr: G!":Yf RAI. CON rR,1C i ok for net+ GC. ai apnUcahlr!
PRINI'NANIr Benjamin Jimenez
State of Flonda. coaa1+ of St Lucie Cotnttt
I'he f lo%%tne ut trtttnent ssas acknot%ledgLd before me this
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Notary Pubftp State of Flpr.de
Hannah E Moore
of
My C OMMISSW HH 017og;
Expires 07t01f2024
PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
BENJAMIN DREW S PLUMBING & DRA1N SERVICES, INC. have agreed to be
(Company Name. -Individual Name)
the PLUMBING �`_ Sub -contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) (Primary Contractor)
For the project located at
(Project Street Address or Property Tax ID A) `
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.
IL%CTOR SIGNATURE (Qualifier)
W Bryan Adams
PRINT NAXIE
29_TY179 _
COUNCER'fIFICAT10,NNUMBER
Slate of Florida. Couch of St Lucie
The foregoing instrument was signed beforr me this day or
e&(U.e_ry , io�y W Bryan Adams
who Is personally known _or has produced a
as iditflirKatiom- n n n
5TANtP
Sig rr of No} ry Pablie
r
`\y��1111tilllil11i1�/
Print Name ofi�iolary Public ��\ S zi $r'� 0- /"Il
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kev"ed 11 16,�016 + yo:.y IYFW tO81ri 41;��
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SUB-CONTRAC CNATUREtQualirier)
PRINT NANIE
29656
COUNT%' CERTIFICATION NUMBER
State of FlArida. Count) of ST LUCIE
The foregoing instrument was sknedd ,b,.eforree ewe this dal of
who is personally known .V/�-r has produced a
as Identification.
+��fr�u": ANGLE PERQOMO
+�. nisi Notary�t�� p5tate of Florlda
Signature of Natar) Public Commission >E NH 47988
ar r�: •' My Comm. Expires Sep 29, 2024
Bonded through National Notary Assn.
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Print Name o atary Pu tic