HomeMy WebLinkAboutChange Of ContractorJANNING & DEVELOPMENT 1'RVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
MAR 19 2®i8
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.
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 i to 20 ` Permit Number: l _cog
Site Address:
J1- ' State License{" 0�2.(( SLC License
Original GC, subcontractor or owner/builder
in a�(J State License(,ZN2.C?4S1 SLC License
New dt, subcontractor
Reason for Cancellation
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
contractor/s contra r or cancellation of permit. A permit cannot be c e11ed if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIG GENE CONTRACTOR(ornew GC, as applicable)
PRINT NAME(�jy
�,, W DikL%1fZYI PRINTNAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
N day of t,"L_kk__ 20A, by
946OL&A who is personally known to me
or whofiTs—pra ttped as ID.
Signature of -Notary Date m fhr
Revised 04/15A 6o40 ¢°vo
2, o
•-5'�DF 4�'°2'
Notary P ti State of Florida
Sandra Leone 0251
My Cam0811o120 0 ,
Expires
State of Florida, County of St. Lucie County
T following inst men was ackn dged before me this
day of Ll(� , 20_by
l who is personally known to
me or who ha p oduce as ID.
C sa����
Signature of Notarn• Date
of Florida
�PRv nu9
Notary Public State
Sandra Leone
My Commission GG 020251
y� o eti°2
Expires oBI10/2020
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PERMIT# I 1-11-2— ISSUE DATE I
PLANNING & DEVELOPMENT SERVICES
a
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Benjamin Drew Plumbing
(Company Name.`IndividUal Name)
the Plum
bing—._._..—_ — "'V-
Sub-contractor for
(Type of Tradc)
For the project located at _ IT10- QWU
(Project Street Address or Property Tax tD
have agreed to be
D R HO_RTON INC
(Primary Contractor)
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 ofSub-contractor notice.
CQYTRACTOR �GN.ITURE (Qualificrl _-
Brian W. Davidson
CRC 1327068
MUIViI' CERTIFICATION NUIIIDER �T � -`
Stale or Florida, Count) of Brevard
The foreolnp lastrumcc{(urol; 310cd hefore me this day or
21 . bf
n ho Is personally knoll n _Xor has produced a
as dentificadoa
Sip
u f NotM Putsllc' � SrANIP
Prinl Name OfNolarp Public
it-0111 I I W-016 j :R .Tt ��( •. 'aL?... ,J V
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SUU-C Vl it,\I tOR SICN:tT URE tQuatlncr)
Benjamin Jimenez
PII T N,1\tE
_ CFC1429456
COUNTY CERTIFICATION NUMBER
State of Florida, Count)
T hr rrurmotaq Instrument w sisaeJ hefarc me thls,!QQ 't}at o f
Awt
ssho is personalty known X or has produced a
xs Idcnttricallo
Slgaaturco otaryPubllcSTAMP
1 29/y�
Print Nomc or Notary ruhUc
,pFC C�.„� s!r.;,;;y F%i•`.Y C ut1iU V' rtGflC7.