HomeMy WebLinkAboutCHANGE OF SUB-CONTRACTOR AGREEMENT1�
COUNTY
r L a R r D A _ .
PLANNING & DEVEL0PIIEN7' SERVICES
BUILD
111IG & ZONING DIVISION
Z300 VIRGINIA AVE
FORT PIERCE, FL 34992
(772)462-1553
S
FAX 462-1578
C%
PLEAS[; Si;LEC"i (} E UE -ri 1� INC,:
� CIIiANGE OF CONTRACTOR - Change of Contractor is to be signed and notarized b • tilt Property
and the new contractor ofrecord for the eurrenl permit. A 1)ca permit allplication lntlst also 1)c completed �tilth ncMM
p pert} owner•,
cot)tra(,tor information and signature. A new Notice of C'umn)cncement must be tiled in (hc near contractor's name
for job 4d1UC$ greater than $2,5{}0 (57,50{1 if A: C• Chlinge-out). A recorded copy' must be submitted n
conunencilig any work. There is a $Sp,Dp fee for lilt Change of C'rrrtt+actor.
x pat to
C'lIANGE ()l SUBCONTRAC I'OR -- Subcontractor changes are to be corn leted b ' the v
The new subcontl•aetol• must till out a Subcontractor A4green)ent Form. There is a �Sp.pt} fee for the Change of
P ' S ,
Contractor. encral rot}tractor.
g Sul}-
_ _ Cion of permit
OF !'! !Z_�l17 - "Gilt cllnectlation of.l pernrt Is acceptable only it no work has been clone.
('anceilati(�n of permit is to be Signed and notanzed by both the owner and qualifier of record. There is
no fee for
cancellation of the permit.
Date: _ t 2�
� Permit Number:
Site Address: r - —
Original C:;(.', Subcontraclor or' i)�ti'1)crllllildcr Stale License e4fJ'? >y3 ! t* Livemse
New C)C.', subcnitu'aclnr �Statc L iccnse (� S�SLC,
- f.iccnse 304
Reason lorC'anrellation ...-���n,�.r,`G� �SPI,+(�•lr�
W he undcror da dncs lterc by agree In indert)nify and hold harnile$s St Lucie C'ourtty, its otlicers. agcrtts and cmpfo� yeey {ro(rl all
cods, Feeti or danuzgr s arisinK fount slay acid all claims nf:lrtian tilt any reason, which i -S arisc cer as a rtsuh of filmy change of
��+11U i7Clil1'�tiL{t?CUn(1JCrpr or cane llat:on of 1) rink. A permit cnrenot be. c:rncef ed if ►cork has been performed.
DAME
R f nr uwttcr�bu ildorj ANCTO�t�(_jor_;,
--y�,,rGk ac appi0cu6 e!
1'Rr'iT NAME _T
S(a(C Of I-itttI(ILI. C(4rrlt) of S( 1-11Coe CWlI, `I _._ _-
The thIlLitalug itt;roantcn( ua;;
iclirr•.,Icdnl beA,re nor (lot.
!_day . I
�(!
w� -�, .. . SJS ���,�!in n Ee1zonalty l>to�vn lu ❑,r
or w1f t}r, prude- Ctj D
as !D.
Sign fnrfiarr\OWn' ?)art!
- fit^• y f'_rriPub(rt State G( FLorwda
Hannah E Moore
My Commrssrcn HH 0170%
�1, n� Expires O71ot,2024
S'At" (Lf l'?011lla. ('pmnt'j O€Sr. Lni r,- COIH`ty
fate l`(,r1O1":o9 rn'(nrnnnl %6a; acknowied-ed b:lt)rc rye thoti
2k ttry nI V rl
a_++lr=r r7srmaI nku t,,
e rw ('hasp w
d� to
Siva lure orNotxrp Mite
R
Notary Public Slate of Flo tlaHannah E MooreMy Commission wi u ir0gg
Expires 0710142024
PERWO I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Ehman Electrical Contractor, LLC have agreed to be
(Company NameJlndividual Name)
the Electrical Sub -contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) -- — (Primary Contractor) —
For the project located at _ LNP -� n__
(Project Street Address or Property Tax ID 4)
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 purstiant to the
tiling of a Change of Sub -contractor notice.
2
654TRACTOR SIGNATt RE IQualiBerl
W Bryan Adams
I'RUNT NAMENAME
29179
COt'N"' CERTIFICATION NUMBER
State of Florida, County of St Lucie
The roregoing Instrument in as signed before me this _day of
W. Bryan Adams
who Is personally known or has produced a
as idratirrtlion. . .
Revised i I.16.+2olti
STAMP
ST�rq��i
tea_
�O� �' fFW I061iT '
STATE
St'ILCOVTRAC'rOR IGNATURI (Quslilier +-LL
I
Timothy L Ehman
tillI%TNAUt _-_.
31748
COt-NTY CERTIFCERTIFlli tA— OMN NOIBER
Stets of Florida, County of ST LUCIE
The foregolag Instrameal was signed before mt this .(- day of
�.t .2kL44, Timothy L Ehman
who is personatb known X-or has produced a
as Ideatlfir lot.
STAMP
N alu . of Notary
^-blk
lu
Print Name of notary Public
QNotary Public State of Florida
fLaura Townsend
n�K MyRH 175435 on
OF Exp.911312026