HomeMy WebLinkAboutChange of Contractor r
_,.._.._ ..............------- PLANNING &DEVELOPMENT SERVICES
BUILDING& ZONING DIVISION
° 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)4624553 FAX 462-1578
CHANGE OF CONTRACTOR.SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELF 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 AIC 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 ate 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: Iq l 039
Site Address: y� cl 1 Ir C b b y
G&G Electric,INC State License EC13002278 SLC License 13727
Original GC,subcontractor or ownerlbuilder
O'�& State License EC,\ �SLC License`A4')S 17
New GC,subcontractor ,.1
Reason for Cancellation �.e .Q U (:l Q 0 T ll G C 10 C
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
SAci�
tor;subconor cancellation ofpermit.A permit cannot be cancelled if work has been performed.
ER(or ownedbuilder) SIGNATURE GENERAL`CONTRACTOR for nc.i GC.as applicablcj
PRINT NAME Bryan Adams PRINT NAME_Q �A_
State of Florida,County of St.Lucie County State of Florida.County of Si Lucic County
The following instrument was acknowledged before me this The following mstruimm wts acknowled-ed before me this
h�
U day of MCI 1rC ti,20 aQby _day oC_rr b,-
Bryan Adams who is personally known to me who is personally known to
ar who has produced_ �10 ^e nr who ha produced__._ __as tD.
�ata1A�oNotary i ture of Notary Date
ro�tR�Pv� 4NME L HARNER
4' S my commissloN a GG o89122
Rev i s
e EXPIRES;Apn12,2021
RICHARD DOUGLAS JOHNSON yrror fop 5M-4 Tryy Budget Notary SWIAM
as ems' Notary Public-State of Florida
•. r• Commission#GG 084021
�.•,L9 ov My Comm.Expires Mar 20,2021
bonded hough Nafronal Notary Asm.
PERMIT# ISSUE DATE
" ]PLANNING & DEVELOPMENT SERVICES
WimBuilding & Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
AAPEX Electric _ have agreed to be
(Company Name/IndividuaI Name)
the Electric Sub-contractor for Adams Homes of Northwest FL, INC
(Type of Trade) (Primary Contractor)
For the project located at---5 d 0L- Y G O b -..-- - --—
(Project Street Address or Property Tax ID")
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.
_\ .-._—_._ .. _ ___ . _--_—_--
TRAC'rOR SIGNATURE(Qualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)
W. Bryan Adams
PRINT NAME PRINT NAME
29179 Qc.t� 9 14-'s
COUNTY CERTIFICATION M NUBER COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie_-.,. State of Florida,County o
++
The foregoing instrument was signed before me this 1 6 day of The foregoing instrument was signed before me this 1 D Jay or
W. Bryan Adams ct •J0.Kgby P LQ\- • _
who is personally known_.or has produced a who is personally known�Lor has produced a
as identification. as identification.
oitgy PC,,, JPJME L HARNER
uk� STAMP _ JA 4 °*I{f G15A dWON#GG 089122
Signature of Notary Public i ature of Notary Public
�� o< EXPIRES:A012,2021
�lFOF Z�F` Bonded T`wt 9aGJet Notary Services
l C1nG rGA p. _�a h 1n S o � moo � ,
Print Name of Notary Public VnntN2me of Nta ory Pubhe
RICHARDDOUGLASJOHNSON
Notary Public-
state of Florida
t� ' •= Comm!ssion#GG 084821
R' is• d(!!II 16 My Comm.Expires Mar 20,2021
Bonded lhmghNatiorcal Notary Mm.