HomeMy WebLinkAboutChange of ContractorPLANNING & 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: 3 I 4MG
11,
Permit Number: I" 1 1 1' b05
Site Address: U V— l Wyl t X y 1 u m NO
G & G Electric, INC
Original GC, subcontractor or owner/builder
State License EC13002278 SLC License 13727
�Q `A FAP-CKe ,CG State License Ej=. MSLC License l"S I
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
`coin—trraaacttov's�ubcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER-(or�wnedbuilder) SIGNATURE GENERAL \CONTRACTOR for nex GC. as applicab;e)
PRINT NAME Bryan Adams PRINT NAME1_.'—!�)
State of Florida, County of St. Lucie County
The following inss uu ment was acknowledge before me this
day of 1 1 [. {K h. 20ab by
Bryan Adams who is personally known to me
or who has p�roduce_d.,�tt _ ` ' e as ID.
SPX �u� 401M1�^'�"`
Signature or Notary Date
Revised 04/1 /
p ..,
RICHARD DOUGLAS JOHNSON
Public -Slate of Florida
OR
Notary
Commission #GG084821
Comm• Expires Mar 20, 2021
oF€
My
bonded thm"ghNalionalNolaryAssn-
State of Florida. County of St. Lucie County
The following unstntm'nt was acknowledged before me this
��day of rC . 20by �� Uft0W
who as personally known to
^e or who has producedas ID.
i lure of Notary Date
2Q1tAr Puk MME L HARNFR
* * MY COMMISSION # GG 089122
E)(PIRES: April 2, 2021
;e1F FLOP UnIL-d Twu Budget Notary Sar
PERMIT # I 101
0 11,
f, At < � I ISSUE DATE
PLANNING &. DEVELOPMENT SERVICES
Building & Code Compliance ]Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
AAPEX Electric
—M � -� __ have agreed to be
(Company Name/IndividualNime}
the Electric Sub -contractor for Adams Homes of Northwest FL, INC
(Type of Trade) (Primary Contractor)
For the project located at 5 D 9 CA1 I y S V0 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.
TRACTOR SIGNATURE (Qualifier)
W. Bryan Adams
PRINT NAME
\-29179
COUNTY CERTIFICATION NUh91ER� W
State of Florida, County of St Lucie
The foregoing instrument was signed before me this - n day of
Pf P V I 260by W Bryan Adams
who is personally known ____._or has produced a
as identification.
SpU/B�-CO�N�TRACTOR SIGNATURE (Qualifier)
INT NAME
9- - COUNTY CERTIFICATION NUMBER
State of Florida, County oPEA—L�;e—
The foregoing instrument was signed before me this $Udac of
who is personally known
or has produced a
as identification.
oirgY PuB�� JAWE L HARNER
L STAMP— z ••., ° W C6ifXW0N # GG 089M
Signature yature of Notar Pu
*-tL-rR Notary PublicEXPIRES: *12, 2021
9lFOr ro' Bonded TM. Budget Notary services
Print Name of Notary Public Prin�tN`me of No ary Pu he
,.•tpav'P�;a.,;
RICHARD DOUGLAS JOHNSON
• ; + • =
Notary Public - State of Florida
Commission # GG 084821
o�:'
Rev' "a; f6
My Comm. Expires Mar 20, 2021
BondedlhmughNalionalNolaryAssn,