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HomeMy WebLinkAboutCHANGE OF CONTRACTOR RECEIVED NOV 15 2021 Planning&D0460ment Sertrices St.Lucie County Biwaing&.Code regulations-1�1VlSim Permitting �. 2300 dirgittta Ave: Fort Pleroe FL 34982 (772)462-1553 Fai:462-1578 CHAANGE-OF CONTRACTOR.. Ur:Subcnntactor or Cancellation ol''Pertiat . Chali , ;f Contractor;; s to be completed by the property owner atmd the;i>iew contractor afi edrd.f©r tl current;permit: A new permit appikahon must-:also be:completed with new Contractor information; signature; and:icansfer fee; A:;new.Nohce;of Commencement must be ffled--u[ th teaetor's .. aname.fur.job values greater than 2,500:($'�,50Q IfA/C Change-oat). A reeorded'.�copy must`bey submlttcd prtoir to commencutg any work. Subc6ntra wr changes:can be.completed by the general contractor Absent extenuating clficumstances; a caneellanot of perrivt Is tt be expcut'&by both die•owner`anti tlualifier of record: Date:: ':1VOW. Pera►it plumber. StC21o8=0269 Site Address*. 616:savi6na-igt.FortP,ieice,..Fl n t � lec'EtiL StateLicense License-.2351c-J otriglnal:General.Com actor,tor Subcontractor) Mimi Eiectnca1:06h actor LLt EC730D9567 .. . . State-License S`LC License • New General Contractor(or Siubeontractor) Reasan'.for Change nwrtet profe..ai�nre The i:ndarsigned does:hiere.y::agree to indemnify and hold hamiless St:Lucre+ busty,its o$bc s agents;aird emplayees:firomA costs;feesor damages aristng'from any:and ail claims of_action;for :any reasatt,which may arse as a result of this change.af contraetorlsabcuntractar tir cancellatinri of" ,. . pernut, r perm t catiaot be.cstncelled if work,,has beewperformed. SIGNATURE bF OVink{or owner'/buildci}` SIWATME: ENERltT CONTRAC'rOR- PE Ix+iT'NAME F'RINTN ` �4, - r state ofFwiu COU ol.sL Ludo epoty Statc ofFt�irida,.County af:St Lucre Cou:uy e followutg msuument was eeknowled& before rne:#liis Thee Mlowmg imiuinot`:wax ael w46dged before mo this: day,of 2t) by ".! day ofV _ ,20 2�by ` •. Y11 e who is personally know io me Who's arvbo has rro�t�ccd. as ID or w as svclaced as IL►r L4 Signs bmdNotary Date y740 a *flrtly sgnetue required for, change of subcontractor "'"a ItU,IlttAiltAT�idZQ Revised.:071211zA` .�;; ;61YC4'IU�d1S31l3#Csfi32tT9513 y. '.:.:SaididlfgdF�ht1!F4l�tdlndMwlt� ; PERMIT# ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division COUNTY BUILDING PERMIT SUB-CONTRACTOR AGREEMENT have agreed to be (Company Name�individuai Name) the_ EC- ,(in Sub-contractor for j 9:' , lAer "Type of Trade) (Primary Contractor) For the project located at (..2! rir") . I 41 `f1 t . �C (Project Street address Or Property Tax ID 9) I - I It is understood that. if there is any change of status regarding our participation with the above mentioned proiect,the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the tsllm_ of a Chin e of Sub-contractor notice. till A/ C . : ACT 4TL'RE!Qualifier} SL'BTRaCTO ATCRE(Qualifier) PRINT NAME PRINT NAME COCA CER ICAT VNIBER- C01'\TY CERTIFICATION'NUMBER State of Florida,County of State of Florida.Counz<of The-foregoing instrument was signed before me t—u his day f The foregoing instrument was signed before me this day or h ho is personally-known >orba�sproduceda who is personally known_.___or has produced a as identifcatlon. as identification. LTAXIP �•x��F�- f t STAMP Siena o Signature of Notary Public ?«pY PV••.,t MEL SA ANN MCLE ?a�; � '•: Notary P bite State of lorida I' q? Comm sion d HH 1 2219 Print\. a .......... ' ty fttowin. G 12, Print Name of votary Public •......9onded through National Notary Assn. Boa+'ftuNotary Public State of Florida i Laura Townsend My Commission +? ' HH 17S435 Revzee :. :o-';fio °iM1 Exp.9/1312025