HomeMy WebLinkAboutCHANGE OF CONTRACTOR14,ANNING & DEVELOPMEN1-,;Z.RVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE MAR i g 201�
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 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, 161 2 k� Permit Number:
Site Address:
State License 0 Lo SLC License
Orig Mal GC, subcontractor or owner/builder
1l� State LicenseeXN2_C?qS_(o SLC License
New , 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/sub ontractor or cancellation of permit. A permit cannot be c Bed if work has been performed.
SIGNATURE OF O or owner/builder) S NA GE L CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINTNAME_�AdA�tik
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
_day otA1 t�-. , 20JJby
flyS who is personally known to me
or ho I produced as ID.
Sr a of Notary Date
zo�0qK �Rkv iis`'oa NMytaryopublic USlaw
700
f Florida
Sandra Leone 020251
Commi--
0Revised 04/15/16 a ires�
State of Florida, County of St. Lucie County
T e ollowing instrumen was ackrlo �dged before me this
day of �. 20 1, A by
who is personally known to
,me or(wM
produced I,- ID.
Signature of Notary Daterr.
Ivy Pu otar/ Publlc Slat' of Florida
?° <'34o Sandra Leon,
n GG 020251
Expire— 0811012U2o
A \,
PERMIT # I I a' [ I ISSUE DATE l
PLANNING & DEVELOPMENT SERVICES
®� Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Benjamin Drew Plumbing
_._.___.._r__w.�.-.-..._have agreed to be
(Company Name.'indi�•idaal Namc) ------- ----------------- -
the Plumbing _-� Sub -contractor for D R HORTO_N INC
(Type of Trade} ' " (Primary Contractor)
For the project located at _p�y
(Project Street
C0b6LaVm e - oe--
ur rropeny I ax I17 it)
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.
Brian W. Davidson
PRINT N,V1[g _
CRC 1327068
COUNT!' CERTIFICATION NUM11pER
State or Florida, Count) of Brevard _
The rorcoing lastrumcnt a•as signed herorc me this aay or
N4o Is personally knoll a -&or has produced a
as cica"cation
_ K _ �STAMP
Sfprta rNotary PubQc
Print Naate of Notary PubUe
"r
t CuL} J
RIwtsttl 11 16/2016
tGar°va'°�,7j�\.i'..;
� ;•r'"v:".. `,."'4r''Vo-Y
sutl-e uailnerl
_Benjamin Jimenez
PRINT N,%xI—E
CFC1429456
CO� �NTY CWWICATION NUM1IiIEH """
State or Florida, Counq or.__.,T Y /
The rurcgoing Instrument was slhacd before me this Ip day or
_A-( d1211f V,fly -----
silso Is personally known X or has produced a
as PIN
i
5lgaaturca otaryPubllc STAM1IP
c..JGiiZtxiL� L/LBiL�
Print Namc or Notary Public
Pq,
' i �`�,'•; ^� N tt r�::t:y ;,t�>i L' a!Jttt Of rtC We
'+4. i':�r'r u`'� iX.:9: i:L •_ r::".:f12i)