HomeMy WebLinkAboutChange of Contractor ;......._..,..._....._..,,.,_ ...4,,..::.:..' .. PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
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:, r✓
6
Site Address:
G&G Electric,INC State License EC13002278 SLC License 13727
Original GC,subcontractor or ownerlbuilder
Q }ate State License E A?-tLMMSLC License 80'5 1'l
New GC,subcontractor D �p �n },
Reason for Cancellation r� R UI CAr� �/ 1 Y 1 CA
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
contractocontractor or cancellation of it. A permit cannot be cancelled if work has been performed,
438 A F OWNER(or ownedbuilder) SIGNATURE GENERAL CONTRACTOR for nc••i GC.az appliwb:eJ
PRINT NAME Bryan Adams PRINT NAME IL_ OhU�_�� -
State of Florida,County of St.Lucie County State of Florida,County of St Lucic County
The following instrument wos acknowledged before nil•this The following insiniment was acknowled ed before rgemethis
adayof MCA VC h.20 VD•by 9jiLday of�,�G�.20�1 by—�;e��-Y 5�+�. OV'O
Bryan Adams wtio is personally known to me who is personally known to
or who has produced_ as ID Mee or who has produced-_„___.___,as ID,
IJI a v 1 ad �,. .�a v-Zv
Signature of Notary Date �ture of Notary Date
=009- P°k WME L HARNER
�ICHARD DOUGLAS JOHNSON o J My CommtSSION fl GG 089122
Fe °.s " �YcS J i Notary Public-Slate of Florida EXPIRES:April 2,2021
. : • •z Commission#GG 084821 ��,Fa'�Oart
My Comm.Expires Mar 20,2021
•'•'Zyi',i;;:�' BondedlhroughNal'ronalNofaryAssn.
.'A
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building, & Code Compliance Division
e �
- _.,.._...:_,.....,.._: .. BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
AAPEX Electric _ have agreed to be
(Company Nameilndividual Name)
the Electric Sub-contractor for Adams Homes of Northwest FL, INC
(Type of Trade) ('1 (Primary Contractor)
For the project located at- `-1.
(Project Street Addreds or Property Tax ID:I)
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.
TRACTOK �TRF-CQualifier) SUBCONTRACTOR SIGNATURE(Qualifier)
W. Bryan Adams
PR1NT NAME PRINT NAME
29179
COUNTY CERTIFICATION NUhaf3ER COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie Stale of Florida,County orEA_L1, \e p
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this O day or
za—Rby W. Bryan Adams20-L by?a,Q\. _
who is personally known__or has produced a who is personally known�Lor has produced a
as identification. as identification.
^ , `^ Pte4 JAIME L HARNER
STAMP e�i ld/� # c*MY C A1XWON tt GG 089122
Signature of Notary Pub' i ature of Notary Public m� o EXPIRES:April 2,2021
Bonded T 6-.Budget Notary Services
1 C1i C1 rC1 ). .lam 1n n S y �lam_
Print Name of Notary Public nR'nt Name of Notary Pu he
+Y < RICHARD DOUGLAS JOHNSON
Notary Public-State of Florida
Commission#GG 084821
Revised I I'1 2t3 ' cµvv,; My Comm.Expires Mar 20,2021
Bonded Through National NolaryQssn.