HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA. AVE
- . - FORT PIERCE, FL 34982
(772)4624553 FAX 462-1578
I'
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: 64
Site Address: T'9'Y I
G&G Electric,INC State License EC13002278 SLC License 13727. ,
` Original GC,subcontractor or owner/builder
State License EU g1SLC License al'S I1
New GC,subcontractor r / r� r, p�
Reason for Cancellation ni p A (A cA � O 61 o n �1 �1
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
contractorisubc ntractor or cancellation ofpermit.A permit cannot be cancelled if work has been performed.
tGNATURE OF OWNER(or ownedbuilder) SIGNATURE GENERAL CONTRACTOR(or nc&GC.as appliwb:c)
PRINT NAME Bryan Adams PRINT NAME_ �e_ 4U
State of Florida,County of St.Lucie County State oFFlorida.County of St Lucie County
The following instrument was acknowledged before me this The following instrument was acknowled,ed before rpmeeiihie
aday of MP r C�R.20_IDby 9,U—day of_JnAJ0it .20U by—
Bryan Adams wtio is personally known to me who is personally known to
or who has produced_ ID. aLc or who has Produced__ as ID.
Signature of Notary to �ture of Notary Date
2'01 PUk JAAME L HARNER
Rev r My COMMISSION#GG 089122
"Y P� =LASJOHNSONtAS JOHNSON mom', Po EXPIRES'Apn12'2021
a6, �,r,' State of FloridaFor ttio�t3orW rtva&riget Nervy„ #GG 084021N*,tt'i ,f es Mar 20,20217tionaINolaryAssn.
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
e
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
AAPEX Electric _ have agreed to be
(Company Name/Individual Name)
the Electric _ _ Sub-contractor for Adams Homes of Northwest FL, INC
(Type of Trade) (Primary Contractor)
For the project located at—TU-D_0__.► t t " n (� _
(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.
TRACTOK SIGNATURE(Qualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)
W. Bryan Adams
PRINT NAME --_.--- PRINNAME
_.
29179
COUNTY CERTIFICATION NUh7BER COUNTY CERTIFICATION NUMBER
State of Florida,County o,St Lucie
State of Florida,County
The foregoing instrument was signed before me this 1?day of The foregoing instrument was signed before me this U Jay of
MCIj 20DPby W. Bryan Adams MCt 20ZDby QC.3,l7t �CY1Ot
who is personaly known__or has produced a_ who is personally known�—? or has produced a_
as identification. as identification.
o"Ay Poec� JAIMELHARNER
STAMP a * o*MY CJRAW0N#GG 089l22
Signature ofNotary Putb`lilic V1 c r� y�� i ature of Notary Public e EXPIRES'April 2,2021
1.1 t to r r� D. l�O� G 1L\ 1J 1 at ����, N�rEop rt'l��tjonded 7hti 9uMe1 NotarySernces
Print Name of Notary Public nfr int Name of Notary Pu be
RICHARDDOUGLASJOHNSON
ati <<= Notary Public-State of Florida
Revised W IN201 ;•, I •_ Commission k GG 084021
�`+Ito� T.,` My Comm.Expires Mar 20,2021
Bondad through Nalional No�ASSn,