HomeMy WebLinkAboutCHANGE OF CONTRACTOR2300 VIRGE14U AVE
FO, PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
SCANNED
BY
StuceConty
ej][ANGE. OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
'and the ne 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 v: ues greater than $2,500 ($7,500 if I A/C Change -out). A recorded copy must be submitted prior to
co g any work. There is a $50.00 fee for the Change of Contractor.
cGE OF SIiBCONTit�iC�-OR — Subcomractor char es are to be-com feted -by the general contractor.
g P
The newJ��N
contractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
C CELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellatioof permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
canceDatio' of the permit.
ill
Date: ��� o� % -- � � Permit Number:
ISN DrS�1
Site Addre D 7 �� IAI-5 r 7� Wd - R ere e- /`Z
A4A4&/,5,�� State License 4SLC License
Original ,� ' subcontractor or owner/builder
ri
1,I /C-/� State License SLC License NO :57�
New GC, su contractor
Reason for C Icellation vA11jb�,'� gm_ S)a,3 &�g4e-lze
The undersign" d does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or ages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractodsulil ontractor or cancellation of permit. A permit cannot b7caclled if wo k has been performed.
SIGNATURE OF �' wNER (or owner/Wilder) SIGNATURE GENERAL CONTRACTOR (or new GC, as aWp icable)
PRINT NAME it PSTNAME Ahi1_-C—
i
State ofFlorida, Ionly
of Sc Lucie County
The following in ent was acknowledged before me this
I day of I'.I .20 , by
l� who is personally known to me
r W has =duck ld as ID.
Of
04
Date
State of Florida, County of St. Lucie County
The following instrument was acknowledged b orep�e
_day of�, 20� by 2t1�- bl
who is personally known to
njeor o has produced - as H)
S116turle
of Notary Date
/1 -0� /=/e
00TAR,Y RiBLJC
S* A* OF FLORIDA
2 SR
_w _7 -
Nov 21 1$ 04:07p horizon Pools 7724615675 p.2
PLANNING & DEVELOPMENT SERVICES
I a - Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
I11AK, INC. DIBIA APPLEBEE ELECTRIC have agreed to be
11 (Company dame/Individual Name)
th ELECTRICAL Sub -contractor for HORIZON POOLS, INC.
(Type of Trade) (Primary Contractor)
For the project located at 3075 JOHNSTON RD, FT. PIERCE, FL
(Project Street Address or Property Tax 1D #)
It i understood that, if there is any change of status regarding our participation with the above mentioned
pro ct, the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
ftIi of a Change of Sub -contractor notice.
Cp. RACTOR SIGNATURE (Qualifier) sit: I TU E uslifier)
1
WJ„ E M. CLARKE HN M. APPLEBEE
PRIM NAIVE PRINT NAME
29362
19055
COU CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State Florida, County of ST. LUCIE State of Florida, County of ST. LUCIE
The to' egoing instrument was signed before me this 21 STday of The foregoing instrument was signed before me this 21 STday of
NO 'EMBER , 2018 , by WADE M. CLARKE NOVEMBER 2 1 g, by JOHN W APPLEBEE
who is personally known _or has produced a DRIVERS LICENSE who is personally known x or has produced a
aside lification. as identification.
STAb1r ���� 1Q-?i?L.��rv�l_s_� STAMP
signat i e of Notary Public Signature 6f Notary Public
MEL11SA PARRAMORE MELISSA PARRAMORE
Print 1`10me of Notary Public Print Namc of Notary Public
Revised
ti ?I NctMjL bIA - StaAIMORErida
Commission o GG 125946
?1�oFF Mycorrm.ixpiesJul2;,,021
1 /16/2016 Ba aee tnrough r.atiortl Na!aryAssti
MELISSA PARRAMORE
NotafyPubk-StateafFlorida
Commission I GG 126946
MyCamm.EVires
„•oF �•••'
Jul 23,2021
Ban�dlaeou�Natbnal NOtal Assn_
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