HomeMy WebLinkAboutchange of sub contractor, AC PLANNING & DEVELOPMENT SERVICES
RECEIVED
BUILDING & ZONING DIVISION
_ 2300 VIRGINIA AVE a R 0 2022
FORT PIERCE, FL 34982
Ludie
tY
(772) 462-1553 FAX 462-1578t'Permitting
n
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
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 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: 3-31-2022 Permit Number: -?10`- 034-1
Site Address: s O-Ve c e.1,0.n 1N OoA
01�. erb,cs IVAC State LicenseC6C1'7fb3 7&C License 3�22�
Original GC, subcontractor or owner/builder
GRIMES HEATING AND AIR CONDITIONING State License RA-0018071 SLC License 4426
New GC,subcontractor
Reason for Cancellation NEW A/C CONTRACTOR
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or dama axis' from an nd all claims of action for any reason,which may arise as a result of this change of
contractor/subc ac cell on of permit.A permit cannot be cancelled if work has been performed.
S NATURE OF OWNER r owner/builder) SIG GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME?Q L(1,L-1 J, PRINTNAME JAMES F GRIMES
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County �T �/` e,
Tdayiof
owng in ent as acknowledge of re me thi The following instrument was aclnowledg before me this.r 20 2�by _aay of a�cl� 2(1Z,by Gt ('�t✓l M
r + who is personally known to me V who is personally known to \\\``01i11 P1i1N,,,
t
as ID.
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or who h uced 3-31-22022 e o has produced 3-31 022 �Fl0��i��
Signa re f N Date Signature of Notary Date 1 ;4'444i0 1o�c�u,
2'2 092526
Revised 04/15/16 ,�;w+„ JOYALIPPARD i�;;k-0 Bo O 0��•��
Commisslon#GG2360 .�9,p`ja�b�ded the�c�,•'��`
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PERMIT# 1 CD` 0541`""] ISSUE DATE
.,� PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
• BUILDING PERMIT RECEIVED
SUB-CONTRACTOR AGREEMENT
APR 0 5 2022
51,Lucie County
Permitting
GRIMES HEATING AND AIR CONDITIONING have agreed to be
(Company Name/Individual Name)
the MECHANICAL/HVAC Sub-contractor for �-� U`C r lf-S ��-
(Type of Trade) (Primary Contractor)
For the project located at 38 SOVEREIGN WAY
(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.
CONT CTOR SIGNAT (Qualifier) SUB-
/" ,CPRTRACTOR SIGNATI�-URE(Qualifier)
mi4ar- JAMES F GRIMES
PRINT NAME l PRINT NAME
4426
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of e_ State of Florida,County of� el-1 e
The foregoing instrument was signed before me this —` day of The
foregoing instrument was signed before me this� I day of
202)by (1-� �WC1 t���OAA76) IV l yW Cif ,20�, b/y JGiN�e - & Vi Nt eS
who is personally known or has produced a who is personally known✓Or has produced a
id utitication. as'dentific on.
i (iebzLl STAMP STAMP
a=NotaryPublic Signature of Notary Public
0bh"0*(? Ale ;�
in Print Name of Notary Public \\5��11E PEN��
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MY COMMISSION i1 HN 227893
EXPIRES:June 11,2026 !ate 092526
Revised 11/16/2016 "°i..... Z o•'d 9 A' Q
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