HomeMy WebLinkAboutChange of Contractor PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 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.
z 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:C-��bc�
Site Address: �u p Li 1 1 l Q n y tn'y
G&G Electric,INC State License EC13002278 - SLC License 13727... .
Original GC,subcontractor or owneribuilder
State License Et,\$[tffSg1SLC License(80"S II
New GC,subcontractorp/y ® q (� y� }� �A
Reason for Cancellation I l 4 I d A � Q a I� E D � I V Vt ( t O Y
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 ceason,which may arise as a result of this change of
�oatr ctorrsub trap or or cancellation of permit.A permit cannot be cancelled if work has been performed.
ATUR OF OWNER(or o AT
wner builder) SIGNATURE GENERAL CONTRACTOR for nc-.+GC.as applicable)
PRINT NAME Bryan Adams PRINT NAME U)_1L.,a �
State of Florida,County of St.Lucie County State of Florida.County of Si Lucic County
The following instrument 1w1-,aas acknowledged before me this The following instrument wm acknowled led before me thic:
Q� day of �Y Cr .20V0.by (JLday of�,LG_�.20�by �
Bryan Adams who is personally known to me who rs personally known to
or who has produced_ ID me or who has produced-........-____,as m.
yaw lao ;�a. ,-� � •?.�
Signature of Notary ate �ture of Notary Dote
1tvf
io Pine dA ME L HARNER
+MY CoW StON#GG 089122
v,,sea •oa;tsJf26dARDDOUGLASJOHNSON m tP;•v nt�'" *, o EXpIF4ES;April 2,2021
No Notary Public-State
Florida °rFIF�,OQ' gay T1Yu gadget Notary Services
,�,� Commission N GG OBA821
`+T1tt1r o E My Comm,Expires Mar 20,2021
•••' BWed NolaryAssn.
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PERMIT# ISSUE DATE
l�¢¢ PLANNING & DEVELOPMENT SERVICES
® Building & Code Compliance Division
x e �
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
AAPEX Electric _ _ have agreed to be
(Company NamefIndividual Name)
the Electric _ _ Sub-contractor for Adams Homes of Northwest FL, INC
(Type of Trade) (Primary Contractor)
For the project located at
(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.
I
- t
TRACTOR SIGNATURE(Qualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)
W. Bryan Adams
PRINT NAME ~y PRINT NAME
29179 -E E'-L�2 S 9 2) -
COUNTY CERTIFICATION NU&16ER COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie_...,_ State of Florida,County of }_ta, x.;e—
The foregoing instrument was signed before me this�6 day of The foregoing instrument was signed before me this daY of
20dt?by W. Bryan Adams ,20ZPby?QQk RXXf1ax1=_
who is personally known__or has produced a _ who is personally known)k—or has produced a_
as identification. as identification.
-_ - sg;Aoe� JPJASE L FiARNFR
STAMP �AWOt4#GG 089122
Signature of Notary PubG i ature of Notary Public
c� c` EXPIRES:April 2,2021
1t"OF ZO! Bonded Th%&WRI Notary Services
Print Name of Notary Public fa P-rint Name of Notary Pu he
=00UGLAS
�is4�, °� GLAS JOHNSONa° ,`�'; -State of FloridaRevis i 01 n#GG 08d821�,,I r 7pires blar 20,2D21 Nafional Notary Assn.