HomeMy WebLinkAboutChange of Contractor PLANNING& DEVELOPMENT SERVICES
BUILDING& ZONING DIVISION
® 2300 VIRGINIA AVE
o
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.
x 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: Permit Number:
Site Address: 5LQ D a ( m b �.
G&G Electric,INC State License EC13UO2278 • SLC License 13727
Original GC,subcontractor or ownerlbuilder
QCe'aG State License E.9 LC 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
contractorrsub tractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
�3t ATURE OF OWNER(or ownerlbuilder) SIGNATURE GENERAL CONTRACTOR for new GC,as applicable)
PRINT NAME Bryan Adams PRINT NAME_Q V_Z��
State of Florida,County of St.Lucie County State of Florida.County of St.Lucie County
The following instrument was acknowledged before rue this The following instrument w acknowled red before me this
q2Akday
of CY Ck r C h 20 F Dby U-day of_P)ACGlk,_20U by � L&*-*
Bryan Adams who is personally known to me who is personally known to
or who has produced as ID. m or who has produced__-_ as m.
Signature of Notary Date i tore of Notary Date
=a�►st;PVk dMME L HARNE2
od MY COMMISSION#W 089122
Rev ,seeliSl ar 5/16 RICiiARDDOUGLASJOHNSON * ptp{�S;Apn12 202t
a` a� Notary Pubic-State of Florida
4 rtp6 + Commission#GG 084821 ' OF Flo;'I3or W TNI Ndgot Notary Services
My Comm.Expires Mar 20,2021
Bonded 1hi"Namna Notary Assn.
PERMIT# ISSUE DATE
PLANNING &DEVELOPMENT SERVICES
Building & Code Compliance Division
- BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
AAPEX Electric have agreed to be
(Company Name/Individual Name)
the Electric V Sub-contractor for Adams Homes of Northwest FL, INC
(Type of Trade) (Primary Contractor)
For the project located at ���, Pa k l �Y
(Project Street Address or Property Tax ID d)
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.
TRACTOR SIGNATURE(Qualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)�
W. Bryan Adams p ��
PRINT NAME PRINT NAME
29179 _ ,10 9 __
COUNTY CERTIFICATION NUN'SBER COUNTY CERTIFICATION NUMBER
� l t Y,
State of Florida,County ofSt Lucie State of Florida,County o %e—
The foregoing instrument was signed before me this 100 day of The foregoing instrument was signed before me this Ab day of
A 20gpby W. Bryan Adams 1rn�,zo�by?Q.Q\
who is personally known_or has produced a who is personally known—V—or has produced a
as identification. as identification.
attg pu"'/ JA16E L HARNER
t, STAMP Nq I FM o MY C61 IXJWON#GG 089122
Signature of Notary Public i azure of Notary Public
l c EXPIRES:April 2,2021
9jFOF F<pp\B0r1de(1 TlY1.BUd021 Notary SWMS
RlcHard D. JTJ01�S��1 P
Print Name of Notary Public rint Name of Notary Pu he
RICHARD DOUGLAS JOHNSON
2�w hbtary Public-State of Florida
• Commission#GG 084021
Revised l=1 d; My Comm.Expires Mar 20.2021
8ondedlhroughNarionalNolaryAssn.