HomeMy WebLinkAboutchange of contractorPERMIT # rJ0 s 03 �[1 ISSUE DATE
1. PLANNING & DEVELOPMENT SERVICES
,COUNTY
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
( omp�py Name dividual Name) have a eed to e
the G��LI'�il�� �IF
Sub -contractor for ��IG��CX
(Type of Trade)
(Primary Contractor)
For the project located at
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(Project Street Address or P.
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.
� \CONTRACTOR SIGNATURE (Qualifier)
,PRINT NAME
(Z"d-C - 1� a 3Ps4/
COUNTY CERTIFICATIO N ER
State of Florida, County o
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The to otug instrumentt/%was signed be re me this d/ day of
20k , by
o is personally known _or has produced a
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STAMP
Signatu a of Notary Public
Print Name o714f,O�Expires
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tary Public Stine or Ronda
rances Donza
yCommission GG 092aA0
07/2712021A�
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Revised 11/16/2016
84 "CO CTOR SIGNATURE (Qualifier)
PRINT NAME
&'7cl coo 09�
COUNTY CERTIFICATION NUMBAR
State of Florida, County of
The fore ng instrument was sign efore me thi day of
20& by
who is personally !mown or has produced a
as identification. /i
$kV Notary Public State of Florida
�6Frances Donna
E'
y� ,per My Commission GG 092A�10
,,,.o Expires 071271202/
STAMP
Planning & Development Services
0- J i Building & Code Regulations Division
1i Ji 2300 Virginia Ave.
•W.4
Fort Pierce, FL 34982
(772)462-1553 Fax 462-1578
CHANGE OF CONTRACTOR
Or Subcontractor or Cancellation of Permit
Change of Contractor is to be completed 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,
signature, and transfer fee. A new Notice of Commencement must be riled 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. Subcontractor changes can be completed by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: 6.17.2021 Permit Number: "0/4 3 - 0,' l q
Site Address: 4848 Watersong Way
Carney Electrical
Original General Contractor (or Subcontractor)
Adams Electric
New General Contractor (or Subcontractor)
Reason for Change Not able to do the job
State License EC 1301 2944 SLC License
State License
SLC License
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 contractor/subcontractor or cancellation of
permit. A permit cannot be cancelled if work has been performed.
NIGNATURE OFF O R (or owne /bu' r)
PRINT NAME r/ I I
State of Florida, County of St. Lucie County
The following in ment was acknowledged before me this
day of 20I , by
who is personally know to me
or w Jl 4ias produced as ID.
Signature of Notary ff Date
Q* SIGNATURE OF NEW GENERAL C NT 6 /T
PRINT NAME !� , li J7
State of Florida, County of St. Lucie County
The following i rument was acknowledged before me this
Vn(1 day of 20,
by
ho is personally know to me
or who has broduced as ID.
Signature of Notary Date
:,Ovn,ls,yd
sErj-
ed ora e of of ca�ublicStateofFlorida
Notary PublicState oT FIon�B Frances Donna Frances Donna
0 My Commission GG 092440
r'Ay Commissivr, GG o92440Ex yes 07/27/2021
Exoims 07!..' orw P