HomeMy WebLinkAbout Change of Electrical Sub Agreement.CIFFTY
F I p 11 —
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
OR CANC
PLEAS t_ tiE;LCC T_ CI L O = Tfi 1=UL1_ 1�F Nis:
Ci1ANGE OF CONTRACTOR - Change of Cont,-actor is to be Signed and notarlred by the Property owner,
and the new contravtor of reculd For file current Perini. Anew permit applicatloll must Tiro be completed with new
contrae.tor information and,ignaturc. A new' Notice of Commencement must be tiled in tlic new contractor'a name
for job 'values greater than $2,500 (S7.50U if A-C' Change -out)- A recorded COPS' Inust be Submitted riot
conlmcncing any worn. I'hcre is a $50.00 fee for the Change of Contractor.
x p to
C IIANGE 01; SUBCONTRACTOR - Subcontractor changes ase to be completed by the nencral contractor,
The new subcontractor mutt till outg
a Subcontractor A�_reenlent Form. There is a SSO.00 fee for the Change of S -
Contractor.
:a u b
CANCE1,1. ATION OF 1rI;RrN111 - .I ate cancellation of it Ilertnit rs acceptable only it no work hil-s been done.
('1111cellition of termer Is to be signedand ltotarired by
canncellatllation of the permit. Iboth the olrrlcr and gtlaliFcr ntrecord. There is no fee for
Date: ZL
Permit Number:
Site Address:
subcontractor OF'uwnel.'builder cite License e� QD/"j !_C f.•iecncc
i icly cfC', stfhcclntl.leti�r � � State I cn,eV_ : �g
�7SLC Liccllse
Reason t'ur C':tnccNation — _` •`�^r, � �L 5_ `�
1 he anti rc"r....
- F, trio« m ulncnulI fy and hold harmless St Lucie C_'ounty, its oliirer,. ar;cllts and cmpla�yc�s From all
costs, Fees Ord arising fli3fn ilny afl1d ail clil'1ns of uct+nn F,,r any rcatitrtl, which mast} fiver as a result lit fl1is c11111Ki• of
Ct�IltlilClvl'�tiIIbCUllhaelUl't,r cilncell<Ifroll o1 pelmet A pC1•nlll canllof be CJIlCCt ed FFYY'Orlc has been performed.
SIGNA r1,111L fly UVNStf_,R I t�l' 11w'RCr'hudrlt,'I
SfGf�r11'URE GENI
'R;:rT ri_;r'r C'CILV.I"Ft,\c"T�llttlr,,rrrn�•p f;1•.+►cBprrlrnb'al
r'rtINTNgkrE__�Lrryl�)►1u 't,�_
S.utc of i'haiita, C—MIL ' of jl Luck count
The fi�ll.lYi11L IiKG'J[r1c�f a;li it r[]tn.fclkrrf f•aa,r4 ,lie the.
3i
--
or %vi
Ir
.�,
:as fD.
�DOC
Slott httc of NOran Ilatr
nublrc $fare Of Fluntla
E MooremrSs,on F(M C 107r0112024
Sias: of Ftonda t'oualy of Sr I. ut•ic ('oa 1y
nc� ff)"NvIng uI.,Wnwal ,1a:
Yckr.�,wi d3cd belt,rr r,lc rigs
. 1 day of
' — —! r -`Sd �_,•..hn r. �rrsnnrilylrrotiio kx
t e r who hat. p 'u,,a`d�
Signature of VofrrOve
l
a
llotary Public State of Flor[da
Hannah E Moore MY CpmrnrSsron HH 017099
Erpoes 071012024
PERMIT p ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
Ehman Electrical Contractor, t_LC
(Company Nameindividual Name)
the Beettical
(Type of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for Adams Homes of Northwest Florida, INC
(Primary Contractor)
For the project located at
(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, 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 SIGNATI RE (Qualifier)
W Bryan Adams
PRINT NAME
29179
COUNTY CERTIFICATION Nt.A16ER
Stale of Florida, County of St Lucie
SVILCOVTRACTOR 1GNATURE(Qnulifier) '
Timothy L Ehman
Pitt%T i &ME
_ - 31748
Cot �\T1' CERTIFICATIONY NvRBER
sia re or Florida, County of STLUCIE
The foregotaj Instrument was signed before me this—itday or
W. Bryan Adams TT
who is personally known )Lor has produced a
as idsstirsalion- • _
Itmod I I-i6ao16
STAMP
�0411. Sp S�,T Fy
.�:;k:o�eli(Fi106t77 `+,fir
A%fd thO $, . o
�i • b/ic Untla ��
STATE
The foregoing instrument was signed before me this JLday of
� ,zou,4, Timothy L Ehman
who is personally known K or hum produced
as Idrallfic ion.
STAMP
51=5112re Of Notary Pibtk �y f
Print Name of Notary Public
Notary Public State of Morlda
Laura Townsend
hty commtlesion
HH 175435
m^ Exp.911312025