HomeMy WebLinkAboutChange of Contractor _,...,._.F.,. ..._: N1 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: ��10(� �� V�'0 Permit Number:
Site Address: ` 3 J 'I 50 n 5,e n J O Ito P L
G&G Electric,INC State License EC13002278 SLC License 13727
Original GC,subcontractor or owner/builder
State License EC= CfKZ\qJSLC License&IS
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
�contractorisubcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE wr owner/builder) SIGNATURE GENERAL CONTRACTOR for nc-&GC.as applicWc)
PRINT NAME Bryan Adams PRINT NAME` L••�.J►'L 6t./
State of Florida.County of St.Lucie County State of Flotda.County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
t day of k)AQ'( h 20 pby lGLU—day of�,�GK.20U by _ .Or1 ov-o
Bryan Adams who is personally known to me who is personally known to
or who has produced as ID. mee or who has produced as m.
Signature of Notary Datc i lure of Notary Date
ol,Sf vuk JNME L HARNER
gevi,Scd ggi15� yARDDOUGLASJONNSON * •• csm'�MW0N#GG089172
t�v EXP IRES:Apn12,2021
z° �;,b: Notary Public-State of P
Commission#GG 084821 �Gf F10 UrdEd TM 9i,g t Notary SeM=
My Comm.Expires Mar Florida20,2021
:,H.. Bonded hrough Rawl Notary Assn.
PERMIT# !\ 'J ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
. �� „ }3
'Y Building & Code Compliance Division
o
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
II
i
AAPEX Electric have agreed to be
(Company Name/Individual Name)the Electric, T _Sub-contractor for Adams Homes of Northwest FL, INC
(Type of Trade) l (Primary Contractor)
For the project located at
(Project Street Address or Property Tax ID 1)
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) � 5UB•CONTRACTOR SIGNATURE(Qualifier)
W. Bryan Adams Q
PRINT NAME PRINT NAME
29179 __ ..._ A3-Q)0-9-?1 SR2_
COUNTY CERTIFICATION NUMBER _ COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie
State of Florida,County EA- %e—
o r
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this 4b day of
Y1 t- zobby W. Bryan Adams 19,D rt Zo ZOby QCVk �COS _
who is personally known____or has produced a who is personally known—'V_or has produced a
as identification. as identification.
STAMP i°t?t;,.PUs�ZV VI JAAELRARNFR
MY
Signature of Notary Publi i afore of Notary Public xM#GG 089122
1InLrAw EXPIRES:April 2,2021
p
per) C"Qr c l Sod nSo N ~— ��lFOF 0-0 Bonded T'ui.Budget Notary SWoes
Print Name of Notary Public Irrint Name of Notary Pu Itc
.•t�;Y i•<<,:, RICHARD DOUGLAS JOHNSON
NolaryPubllc-State of Florida
•« U •; Commission#GG 084821
Revi My Comm.Expires Mar 20,2021
; oFF:',•,. BondeditwghNal'wna NlotaryAssn.