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: I a
Permit Number: 19 l a - o& S H
Site Address: _ O ll 1 V I C 1 G. Y t 1' V I
G & G Electric, INC
Original GC, subcontractor or owner/builder
State License EC13002278 SLC License 13727
Q!PQ ` ' e�•�re'aG Mri State License �.� � SLC License S 1
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
— coo-nttr-ac�torrsubcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGN OWNER (or ownt r/builder) SIGNATURE GENERAL CONTRACTOR for neee• GC. as applicab:e)
PRINT NAME Bryan Adams PRINT NAME_I ,>' RC:��
State of Florida. County of St. Lucie County
The following instrument was acknowledged before me this
au day of MQ rCh. 20CIC). by
Bryan Adams who is personally known to me
or who has produced as ID.
Signature of Notary Li DOW
rietja "=bteOUGLAS dOHNSONblic - State of Floridassion # GG 084821. Expires Mar 20, 2021al ugh National Notary Assn.
State of Florida. County of St. Lucie County
The following mstnrmetrt was acknowled red before me this
SL day ofJMAL . 20U by A_Q11.O.'o
who is personally known to
.me or who has produced as ID, r•
i ture of Rotary Date
row; P% MME L HARNER
* * W COMMISSION # W 089122
m� oe EXPIRES: Apn12, 2021
�'FOF F�°p Bonded Titru Budget Notary services
•
0
PERMIT # 101
e ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
AAPEX Electric have agreed to be
(Company Name/Individuat Name) T
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 N)
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) SUB -CONTRACTOR SIGNATURE (Qualifier)
W. Bryan Adams
PRINT NAME
29179
COUNTY CERTIFICATION NUMBER _
State of Florida, County of
St Lucie
The foregoing instrument was signed before methis.SN day of
Y 9 t_ , 201) by W. Bryan Adams
who is personally known or has produced a
as identification.
STAMP
Signature of Notary Publi
Kwhci r d >i x5 xct S JD h y)S o N
Print Name of Notary Public
,•�.�ARY Poi .; RIC HARD DOUGLAS JOHNSON
vise O16 Notary Public - State of Florida
Commission # GG 084821
My Comm. Expires Mar 20, 2021
Bonded through NaGonalNotary 0.esn.
PRINT NAME^~
COUNTY CERTIFICAT ON NUMBER
State of Florida, County ofEA—Lxx 1e—
The foregoing instrument was signed before me this (�' oday of
0� r I L , 20 W by ?Q aQ\(X.3�1:A.ifip
who is personally known �Lor has produced a
as identification.
2a'0 ?a" JPJA L HARNER
* * MY CTAiXW0N # GG G89122
ki2tur0e%fNNof2ry E(p{RES: Apr 12,2921
OF "-aBonded Thn. Budget Notary SennM
Tint Name of Notary Pu he