HomeMy WebLinkAboutChange of Contractor0 •
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: 61 a fi t au
Site Address:
I
Permit Number:
G & G Electric, INC State License EC13002278 SLC License 13727
Original GC, subcontractor or ownerlbuilder
p& ��tQC'^K'aG State License E.C.° MSLC License l'y 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
contractorlsubc or cancellation of permit.'A permit cannot be cancelled if work has been performed.
SIGNATURE " or owner/builder) SIGNATURE GENERAL R
\CONTACTOR for new GC. as applicable)
PRINT NAME Bryan Adams PRINT NAME �1.9.i Z_1
State of Florida, County of St. Lucie County
e following instrument was acknorwWged before me this
day of NYC h , 20� V, by
Bryan Adams who is personblly known to me
or
rrw-h-o nhas produnced as ID.
z �R�I.�Y
Signature of Notary Datc
Rpu,.,Sed
SP%tY F(�•�
4Al1 OUGLASJOHNSON
2'»�«`�°-
• p e
Notary Public -State of Florida
Commission#GG084821
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My Comm. Expires Mar 20, 2021
Bonded 1h ough National Nolerymm
State of Florida. County of St. Lucie County
The following instrument was acknowled red before me thin
SLU-day of R)A C K. 20U by
who is personally known to
^e or who has produced_ as m.
i ture of Notary Date
roOF°�k JNME L HARNER
* * W comm*SION A GG 089122
m� oc EXPIRES: Apn12, 2021
Uoded TM %4A Notate WAces
PERMIT #
AAPEX Electric
0. 03 :
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
(Company Name/Individual Name)
the Electric `
(Type of Trade)
For the project located at
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
(Project Street
have agreed to be
Sub -contractor for Adams Homes of Northwest FL, INC
(Primary Contractor)
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.
__
._._ TRACTOK SIGNATURE {Qualifier)
W. Bryan Adams ^
PRINT NAME
29179 COUNTY CERTIFICATION N—U-NIBER
State of Florida, County of St Lucie
The foregoing instrument was signed before me this t� day of
IA
�l l 20 by W. Bryan Adams
who is personally known ____or has produced a
as identification.
ZLtc X" '�SDA
Signature of Notary Public
Rtchc►rC1 ()• �ohrnSa IJ
Print Name of Notary Public
ta:v'i•� A -,=DOUGLAGLAS
JOHN'ON.
.`�Slat'ofFlorida'#GG084821*
[,,d
5 u r
Mar 20, 2021k
Poires
1, 5�' •
aConal NUz Assn.Rev'1:'16/2016ry
SUB CONTRACTOR SIGNATURE (Qualifier)
PRINT NAME
GC t_169
COUNTY CERTIFICAT ON NUMBER
State of Florida, County o*&_ i Y %e_
The foregoing instrument was signed before me this a pday of
-h!pr IL,20�qby CC%&�) `3s=sf
who is personatly known _N14—or has produced a _ _r
as identification.
o'o po" JAAE L HARNER
STAMP = * MY CIitkW6N # GG 08912Z
i alure of Notary Public
EXPIRES: April 2, 2021
Bonded T'vL Budget Notary Semoes
riot Name of otary Pu be