HomeMy WebLinkAboutChange of Contractor ___ ....._...._ ..... .,._ ......_.. 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: �� a lX 1 DAD Permit Number: 19 1 a— D3 5 D
Site Address: _ 3�b I C,r I S t I I l •C
G&G Electric,1NG State License EC13002278 SLC License 13727
Original GC,subcontractor or owner/builder
State License EJ..& A1SLC License al"S V )
New GC,subcontractor
Reason for Cancellation
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
contractorrsubc r cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OOWNER_�oi dwnerfbuilder) SIGNATURE GENERAL CONTRACTOR for nc%;-GC,as applicable)
PRINT NAME Bryan Adams PRINT NAME_&
State of Florida,County of St.Lucie County State of Florida.County of St.Lucic County
The following instrument was acknowledged before:me this The following instrument was acknowled-ed before me this
U day ofY day of nAC4 .20U by J&%%0Wa t,
Bryan Adams who is personally known to me who is personally known to
or who has produced as ID. me or who has produced as ID.
? U.-EA d%CA&Aman
Signature of Notary c i ture of Notary Date
ro�►st;Poi, JAIME L HARNER
a ev i s d o W COMMISSION#W 089122
RICHARD D:Exe
JOHNSON EXPIRES:Apn12,2021
* �+
Notary Pub01 Florida �iFo SOPt
Comm a820?2021MBonded th o No ary Assn.
PERMIT# ^ .� ISSUE DATE
. a •e PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance !Division
o
_...._._.... 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
(Project Street Address or Property Tax ID ff)
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 SIGNATURE(Qualifier) fONTII;t.AC:TOR SIGNATURE(QualiGcr)
W. Bryan Adams
PRINT NAME PRINT NAME
29179
COUNTY CERTIFICATION NUh7_BE R� � COUNTY CERTIF[CAT ON NUMBER
State of Florida,Count of St Lucie
y State of Florida,County ofEA t ► Y�e_
The foregoing instrument was signed before me this 0 day of The foregoing instrument was signed before me this 4 Dday of
YJQYJ29"by W Bryan Adams ,10. dgby ?QQI ZXGM ►rj _->
who is personally known_or has produced a who is personally[mown)1—or has produced a
as identification. as identification.
STAMP ottg'! � JPJAtELHARNER
Signature of Notary
otar Public * •• •• cv MY C1f7ifON#GG 089122
> Y i ature of Notary Public
�. c� EXPIRES:April 2,2021
"--" 'rFo mow Bonded TTur,Budget Notary Services
�1 C h a r �011 t\s y I`! s Q�� � y �
Print Name of Notary Public rent Name of Notary Pu lie
o
,•�;;Y'P;a., RICHARD DOUGLAS JOHNSON
Mo
Notary Public-State of Florida
Commission#GG 084821
ReviMy Comm.Expires Mar 20,2021
rr.,, Bonded Through Nagond NoWyAssn.