HomeMy WebLinkAboutChange of Contractor _. _,.........___._._.�__ PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
fl 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
I' 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. lg
Date: Permit Number:
i, 2 22,,
Site Address: 5J 5 ) ,S n Q l
G&G Electric,INC State License EC13002278 SLC License 13727,,.
Original GC,subcontractor or owner/builder
IR �Q(��{'a� State License E...U. MSLC License 60" 1
New GC,subcontractor �t /�
Reason for Cancellation t 1 JQ rQ U' 1 ��tY l_
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
contractcir,`slArcqntraclor or cancellation of permit.A permit cannot be cancelled if work has been performed.
�&! AT4E0WNER(or ownerlbuilder) SIGNATURE GENERAL
-�CONTRACTOR for nc•.i-GC.as applicable)
PRINT NAM£ Bryan Adams PRINT NAME
State of Florida,County of St.Lucie County State of Florida.County of St Lucie County
The following instrunimt urns acknowledged before me this The following instniment was acknowled red before rmeetthi,,
lY day of fnQ rC�,ZOaD,by &U—day of�r4&.20U byID—
Bryan Adams who is personally known to me who is personally known no
-An
who has produced as ID me or who has produced_____.,_.
Signature of Notary U Date �ture of Notary Date
2�,ts v PN, JNME L HARNER
AeVi 'nttt�m'�a®e�u'a.�o� * a
MY COMMISSION#GG 089172
RICHARD DOUGLAS JOHNSON ��� O< E}(PIRES,Apn12,202t
Notary Public-State of Florida for ram° Batbe4 TM Budget tlofary St rAces
(` 1 Commission#GG OW21
My Comm,Ezplres Mar 20,2021
V
'•r;;!,!,`.'.:•' EoniledlhroughNatrruilNa�arYPstn. D
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
e �
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
I
I
AAPEX Electric _ have agreed to be
(Company Name/In(ividual Name)
the Electric _ Sub-contractor for Adams Homes of Northwest FL, INC
(Type of Trade) (Primary Contractor)
_For the project located at��—� .&CA n_,-bk ".,(u"-10 1P _
(Project Street Address or Property Tax ID 4)
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 S]GNATURE(Qualifier) S(U�B CONTRACTOR SiCNATURE(Qualifier)
W. Bryan Adams _� ^_
PRINT NAME PRINT NAME
29179 ���-'T
COUNTY CERTIFICATION NUNIBER COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie State of Florida,County o*s�
The foregoing instrument was signed before me this V day of The foregoing instrument was signed before me this day of .
MIN 200)Rby W. Bryan Adams mG - ,zoKqby?Ct,Q
who is personally known__or has produced a _ who is personally known J�Lor has produced a
as identification. as identification.
�� -e (� y� otigy P�B� JAJME L FA2NFR
8J STAMP * cx h{Y CIfXIS�ON#GG OB9122
Signature of Notary Pub' i ature of Notary Public
`_ Ct'r d I YN U) oY EXPIRES:April 2,2021
(] M R ��FOF °t Bonded 1'wti Budnel Notary Sery ces
F`CV)►
Print Name of Notary Public ' rent Name of Notary Public
RIM
HARD D0�NSONfaryPublic-StaleofFloridaCommission#GG 084021RevisCom p es Marm•Ez it 20,2021detllhrpu9hNa!yrnalA�p�ryAssn.