HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & .DEVELOPNIENT SERVICES
4 ' • = BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMIT
PLEASE SELECT ONE OF THE FOLLOWING:
- ZMANGE OF CONTRACTOR — Change of Contractor is to be siimed and notarized by the property owner,
and the new contractor of record for the current permit. A ne« 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 (S7,500 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.,
CHANNGE 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. ,�1
Date: Permit Number: 17 a 'y
Site Address: C000 hz �2 cm,
t� _State Lieens- C License
Original GnC�, • ibcontractor or owneribuilder
0"r-`�-� C4-- State Livens a SLC License
New GC, 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' ubcontractor or ancellation of permit. A permit cannot he cancelled if Work has been performed.
SI(REOF0%CNIiR(or owner huildcr) SI(i;iMURL01-NERAIRONTR.\('TtiRfornewo(',a;applicablo.
PP.I:IF t;?�•t�'tJ((!u!<'� L4,) D11tAQ0AJ\\ PRIN1-NAM ;
State nl'F lurida. ('ounl): of St. Lucie County State of Florida.,County ofS4 I.ocu ('aunt}'
1. a lirllowmg in:itrumcnt wag acknowledged berarL me ihis
day of—2oA. b}'
, •` A9 w o is personally known to me
or who ha pr -ed as ID-
,Signature of ,Notary Date
The following instrummi was ucknowledged betbre me this
day of 20`, by
who is personally,knawn to
me or who has produced as ID.
signmureorNotarq• Date
h •�Jn :�Y aM7�e�w �•1 �` l
Re•rised 44/15/16
�..��'S•o'yj'y
1'
Ms�n.�,� nab 1,.ry State at f�e q',
;°F� 5a.„ire L;.,?r•F+ 1
ry .i Cenm;r %n GG 02-0i6
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PERMIT # ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
Meek & Sons Plumbing, Inc.
(Company Name/Individual Name)
the Plumbing
(Type of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Sub -contractor for D R Horton
(Primary Contractor)
For the project located at 9?3C) C 01'3t r--�
(Project Street Address or Property Tax ID #) '
have agreed to be
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
Fling of a Change of Sub -contractor notice.
CONTRACTOR SIG, o ualifier)
Brian W. Davidson
PRINT NAME
CRC1327068
COUNTY CERTIFICATION NUMBER
State ofPlorida, County or Brevard
The foregoing last rumeent)•as signed before me lhi ' doy.of
2A, by
wh -rs personall sown _or has produced a
as iide tt Cation.
STAMP
Signattfre of Notary Public
Sandra Leone
Print Name of Notary Public
J u. ^,/�: '-.icy �.-'i•`rr.,'.T*f'Yhv�i?°^•���iYi (�
Revised 11116r016
* l} , .VJ;'y.w� u .•�4' .l Yt�l .�2
,�1-'�•1a
David W_ Meek
PRINT NAME
CFC057372
COUNTY CERTIFICATION NUMBER
state or Florida, County of_-
The foregoing instrument was signed before me, thls�— day of
, 20t , by
who is pers ally known _or has produced a
as Callon.
t STAMP
Sig lure of Notary Public
Sandra Leone
Print Name of Notary Public