HomeMy WebLinkAbout22021513_14_44.pdfPLANNING & DEVELOPMENT SERVICES
ICOUNTY
BUILDING & ZONING DIVISION
. 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 sighed 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 contractor.
The new subcontractor mast 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: Z _ Permit Number:
Site Address:
Ridgeway Plumbing I
State License SIX License 19-15354
Original GG subcontractor or ownerrbuilder —
Benjamin Drew's Plumbing & Dra,n Services Inc. CFC1429456
New- GC, subcontractor State License SLC License
Reason for Cancellation Contract Disputes
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
contractoc'subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
DQiY r.�nttl ov Beryamn , -
�SIGNATURE OFOWNFR(orotitnedbuilder)_
SIorimx o7rsysasoaanM`
CNATfIRF "
PRINT tlN4E W Bryan Adams
SlateofFlonda County orSt I.ucreCoimt�
The folloumg instrument nas ackno«ledged before ttic thus
da) of � it . 2p jy. b) w Bryan Adams
%ho isgersonalh kno�+11 Io me
Wasr"ed4 as ID �
Signature or\otary Date
amEOVAtate OI Flpt-de
ore
p HH 017099
24
f . Gt.NU KAL C ON ""ACTOR (or nca GC_ as appl,cabiel
PRINT NAME. Benjamin Jimenez
Skite of Flonda. County of SI t.ucte CnLtnt%
the fullouung instrument %%as acknowledged before me this
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LiftUAILIhoisp'ersonal4krinkti to
me r ti�ho s prod c� as�ID
Signature of Notary Date
R
NotaryPubk State of Flpnda
Hannah E MooreMy Commmsam HH 017096
Expires 071Ot1Z024
PERMIT# I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
BENJAMIN DREW S PLUMBING & DRAIN 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 --5,j ou f y
(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.
TRACTOR SIGNATURE (Ouaiifrer)
W Bryan Adams
FRET NAZI£
29179
COUNTY CERTtFICATIAN NUMBER
State of Florida, Count) or St Lucie
The foregoing instrument was signed before me this } .] day or
CLLb t'I r�rt-! . , 20 ), -b,. W. Bryan Adams
who is personally known X or has produced a
asidti6irKotiom A /i n
Sig re of Nopry Public
"(SQ Print Name or NotaryPublic
Remo! 11 16,2016
STAMP
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SSION
••GH 27,.E
W
y 31HH 100177
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SUB-CONTRAC GNATVRE (Qualifier)
PRINT NAME�%
29656
COURTS' CERTIFICAI'1 UX N UMBER
State of Florida, Coun1) of ST LUCIE
The foregoing instrument nos sigaed before me this 1 -dAI of
who is personally known V/.r has produced a
as Idtmtineatloo.
dhmo
.�r iu .ANGIE PERI)OMO
•? Notaryh�Ij�pState of Florida
5tgaaeure of Nolar), Public Commission p HH 47988
.ISO,, My Comm, Expires Sep 29, 2024
Bonded through National Notary Assn,
L�. _CC i
Print Name o a4n Pu lie