HomeMy WebLinkAboutChange of Contractor .,.,.__.._._..:,.,,,...._:. ._..�.. PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
o
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 Sob 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 owher and qualifier of record. There is no fee for
cancellation of the permit.
Date: Permit Number: :2
Site Address:
G&G Electric,INC State License EC13002278 SLC License 13727
Original GC,subcontractor or owner/builder
State License E� LC License !"S tit
New GC,subcontractor �` r y� /
rA Reason for Cancellation 1J d !Ll G an ol f o n t y c t o r
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
_---apnrtaste ubcontract anccllation of permit.A permit cannot be cancelled if work has been performed.
St NA F ER(or owner/builder) SIGNATURE GENERAL CONTRACTOR for nc-.a GC.as applicable)
PRINT NAME Bryan Adams PRINT NAME .U�_ ou�U
State of Florida,County of St.Lucie County State of Florida.County of St.Lucie County
The following instrument was acknowledged bnrore me this The following instrument was acknowledged before me thi?
Qday of Ch.20Jk,by _day of JnAr4&.20U by--9- O-1-0
Bryan Adams wito is personally known to me %Yho is personally known if,
or who has produced_ as lD me or who has produced--------__as ID.
JkA.&&_ 3CAUI,9 �
0 _ .0 •-tea ` '3- '?.�
Signature of NotaryIla— Date cure of Notary Date
Lb
Puke 4NME L HPRNER
Fie s %Y-5/t 6 ICHA:DOUGLAS JOHNSON * aW coMMI5S1oN GG 089122
, NotaryStaleo FFloridar � EXPIRES:Apn12,202t
_ Co GG 084821 �`FO f F%0' W&A T1Vv ldudgot Notary Serdcesors M Cos Mar 20,2021� µB ded 'ioul No!aryAssn.
l
PERMIT# f` G ISSUE DATE
02
aim&
H L�ANNING & DEVELOPMENTSERVICES
Building & 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 5y 5_1 SA_.- _
(Project Street Addless or 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.
- l
TRACTOR SIGNATURE(Qualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)
W. Bryan Adams --- -- P _ c_�xvD - - -
PRINT NAME PRINT NAME
29179 GC'LI 11�9
COUNTY CQ RT[FICATION NUh16ER COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie State of Florida,County or',�&—t,,,x}r1�-
The foregoing instrument was signed berorc me this day of The foregoing instrument was signed before me this day of
za& y W. Bryan Adams YYIU� IO_�qby_?CQ,)� Onp_
who is personally known or has produced a who is personally known U-�or has produced a_
as identification. as identification.
JAIME LHARNER
STAMP # o*My Cf3ItdI�CON if GG 089122
Signature of Notary Pu 'c i ature of Notary Public
EXPIRES:AFxil 2.2021
R1 C1n et r e�alb h tr"tS D _ �''FOF r`°°�°�tjonded T,.,.SuN�et Notary Services
Print Name of Notary Public me Of-Not2ry Pu be
RICHARD DOUGLAS JOHNSON
Notary Public-Stale of Florida
l Commission#GG 084821
Revistx3ll'I612016 ;9 * +Po. My Comm.Expires Mar 20,2021
�'�o;F�„•• 8ondedlhroughNaliona�Nolarytusn.