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HomeMy WebLinkAboutCHANGE OF CONTRACTORBANNING & DEVELOPMENT _1RVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE - FORT PIERCE, FL 34982 (772) 462-1553 FAX 462-1578 MAR 19 2018 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: (A Site Address: Permit Number: 04t0 Lo State License_C; 05152kt7 SLC License Orig na1 GC, subcontractor or owner/builder Vim, {,�1 " so / State LicensetU42gg5L SLC License New 6t, 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/st contractor or cancellation of permit. A permit cannot be cancelled if work has been performed. SIGNATURE OF OWNER (or owner/builder) SIG T GEN L CONTRACTOR (or new GC, as applicable) PRINT NAME&.6,k W PRINT NAME_ Ia���� State of Florida, County of St. Lucie County The following instrument was acknowledged before me this day of U rkg k- , 20_�K, by Jt,& ,tcQ.Lt who is personally known to me or who has-oroduced l as ID. Signatd-relof Notary Date a Revised 04/157Td Notary Public State of Florida " 1_eone � C i�°4 EzpComo ��1C72020 9?0�51� State of Florida, County of St. Lucie County T4j following ins,�t'}'m��,nt� w��as ackWlb edged before me this day of , 20y Oht/it7iM0&41 who is personally known to me or(�o� produced as [D. Signature of Notary Date _e �aqf roe Notary Public State of Florida ; a° �r Sandra Leone { o My Commissian GG 020251 v� OF�f"pe•�� p es OBl1 UI2020 �i PERMIT # 12©�1P�o I ISSUE DATE PLANNING & DIEV ELOPHENT SERVICES Building & Code Compliance ]Division BUILDING PERMIT SUBCONTRACTOR AtGREVVIENT Benjamin Drew Plumbing (Company Numc.'lndividual Name)have agreed to be the Plumbing Sub -contractor for D R HORTON INC (Type of Tradc) p�� [� �(printary Contractor) ^�"` For the project located at /p b-1 �!j l _f)6W M6A, e Ali/ (Project Street Address or Property Tax ID 11) 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 tiling of a Change ofSub-contractor notice. CnN_ _It OltSI F;(Quallflcr) _ Brian W. Davidson FRINTRITIN CRC1327068 CQUCI�iFICnTION NUMaEa State or Florida, Count) of Brevard 7be forming Iastrumcat Was signed before me thls day of N bo fi personally lato" a A_or has produced a as�dentlfiratioa SIF'. arvmm Pubtle — STAMP P11n1 Name Watarp Public tiU6•C YrR.ICTOitSIGN.�TUftE(Quallltcr►� Benjamin Jimenez I'Mi'll NAME CFC1429456 COLNTY CERTIFICATION NUdlilEii Stale of Florida, County ThefurclulnK lustrumco(wu signed Wore me thls_ dal of / V"W L_t3 __..Ih Y _, by __— ubo b persooali} knou•q X or has produced a as Idcntiricatlo 5lgaaturro otary Public STAQIP Print Namc of Notary Public: ss>i,.Pyt,�'ifP`�J.§,.%•Ly`.r°�I"��r�'vr``'�h.^'1'irwr'S°,`'4f'�:�1t�i'�''d'`�r�t�'r"',%�,.AdeYa'P�P Reves�tl I I 6 �;a tace e:y r' ?r: • r r•' ::,,,. a !oil 16j.01 a y ?� ` 1 .v ' i�r a;cr. •_ r)�'LC.i) t'��-St'tlr.�".,/°v .. "vj`t;':. `<...k ..,�� �wr'v��,�•yq,..w'�s�,,�,.'^F+"ad •r '��V',1'1r``�n�