HomeMy WebLinkAboutChange of Contractor w RECEI I MAY 2 6 2017
i 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 signed by the general contractor only.
The new subcontractor must fill out a Subcontractor Agreement Form which is signed by both the contractor and
subcontractor.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: May 25, 2017 Permit Number: 1704-0124
Site Address: 2311 N 44th Street, Fort Pierce, FL 34946
Kuebler Mechanical Heating&Cooling State License CAC058105 SLC License
Original GC,subcontractor or owner/builder
Evans Air LLC State License CAC1814485 SLC License 3 UO 3(p
New GC,subcontractor or owner/builder
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 re son,which may arise as a result of this change of
contra or/ ontractor or cancellation of permit.A permit cannot be if work has been performed.
^y 111.•
GNATU OF OWNER(or ownerlbuilder) ,�+at••'.46, GNAT
NERAL CONTRACTOR(or new GC,as applicable
PRINT NAME Lionel J. Dunbar PRINT AME Lionel J.Dunbar T.
State of Florida,County of St.Lucie County State of Florida County of St.Lucie County
The following instrument was acknowledged before meth' S 0 The following instrument was acknowledged before me this 7 � p
25 day of May 20 17 ,by m 25 day of May 20 17 by m
Lionel J Dunbar who i ersonally known m N Z Lionel J.Dunbar who is rsonally known t m N z
or h produce as ID. to 3 Z m m r o has produc�VA5/25/2017
as ID. �' 3 Z a
Q 5/25/2017 Q `' A T Q
� „ a
Sig at re of Notary Date Si na ure of Notary Date N
o N c
w w
w
Revised 05/18/2017
MAY"
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
s �
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
St.Lucie County Contractor Certification Number: 3 0y 3/,,
State of Florida Certification Number(if applicable): CAC 1814485
Evans Air LLC/Michael Evans have agreed to be the
(Company Name/Individual Name)
HVAC Sub-contractor for Black Street Enterprises, LLC
(Type of Trade) (Primary Contractor)
For the project located at 2311 N 44th Street, Fort Pierce, FL 34946
(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, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a
Change of Sub-contractor notice. (Form: SLCCDV(No.004-00)
BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License)
NOTARIZED SIGNATURES ARE REQUIRED
Business Name: Evans Air LLC
Address: 3440 Ocean Parkway
City/State/Zip: Boynton Beach, FL 33435
Phone: (561) 667-1823 email: evans—air3440@yahoo.com
Michael T Evans 5/25/2017
SI NA E PRINT NAME DATE
TATE OF FLORIDA,COUNTY OF Saint Lucie County
THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS 25th DAY OF May ,2017
BY ✓ WHO IS PERSONALLY KNOWN X OR HAS
PRODUC D AS IDENTIFICATION.
Kristina E. Davis STAMP
KRISTINA E DAWS
SIGN TU OF NOTARY PUBLIC PRINT NAME OF NOTARY P :�? MY COMMISSIONS FF960833
SLCPDS: 08/06/2014 ,''T4!„�`'
EXPIRES March 08,2020
(A07�398-0'S3 rWidaNwa Sewfcr.cwr.