HomeMy WebLinkAboutChange of Sub-Contractor - Electrical PLANNING & .DEVELOPMENT SERVICES
BUILDING & ZONfNG DIVISION
2300 VIRGINIA AVE
FOR`I' 1')ERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCOI'iTRACTOk{)R C'ANCELLATION OF PERMIT
NLLA.S : Si LEC'7 ONL- t)1.:"fi t
CHANGE OF CONTRACTOR-Change or Contractor is to be signed and nkmarized by the.rroperty owner,
and the netti contractor of'rccord for the em-renl permit A lie"- permit atiptication mtist Also be completed with new
contractor information and sionatuic. A new Noticc of Cummencem'nt rttci_st be filed m the new contractor'!; name
for job t alucs greaier than $2,500 1.S 7.500 if A/C' Change-out). A recorded copy inu,t be submitted prior to
Commencing any wolk.There is a $50,00 fee fnr the Change orCnntractor.
x CIi.A11tGP. OF SUBCONTRACTOR - Stibcomractor changes arc to l e completed hy the general rwirrtctor,
The now subcontractor m'_i;t till out a Subcontractor At�,reeme.nt Form. There is a S50.00 fec for the Change of Sub-
Contractor.
_ _ _Cit NCF;l.l,ATION 01' !'1.lt�91T 1lle cmncelfa:i-m of a periim is acce.%lble only 11 ,ln i4.}I;: 1%:t hcen ciarlc.
f'ar7 Ration of pefmil is to be .lpltetif :uyd 1101anzed b%; l•-crlh the ot%,ner attd cluahfiiOr 01'ieUmd. 'There is no fee for
cancellation of'tile permit.
Date.: - — � Permit lumber:
Site Acldre.-oi: __-P d _ f ..
e4 ( 1_C
Original GC,subcontrac-toi or oNNimAtitililel
Slate l_.ie.cn,ep�-1� �SL(' L.iccil,c. 3r749
New GC,suheomi,10m'
Reason fur C'mucllmiou rp
I he undersigned time;hire by apve in indenl:irl.y sud h,)!d t1!mitess St Uxie Cowaty.its oflie-ers•jgcirts grid cmglttyres until atl
l'q iS� ferti c+r dans.�racs arwti ,fwtfi wly arid xt':htm1ls ftracdon t,?(.Roy ressfyll,which 1111) alive:ls:1 reiat[lit this f ll;lllg; I+i
cw�r-tl;ut„t'.ubcuniis�iatl t+r rinCCII- 1011 0'1ktimi A permit cannrut In cancel ed if work has been performed.
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t'it['dt M{m$_.�i
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t� _cla,- ,l� b 'it2 .'^_ _ _ roaY+•ryYL�h CF �'111—
I/v .. S.q. ,�rYr,is het gr,3l ly l]:d.rt W tl►c �.- l � 1 1 t!� �:,,li_..,ilrai.xit}t n.wr :c•
,r w' h I �rudr a ,, as it] r r at rr Im.r r t.4
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lh •nr ovary Date lu e a ) r 5 kn itt N 5ignx r of;\ tary� t a r
=PijbfNO-LaryG Slale d F for as-P•st£,r jr��uoic State or Ftnr.:a MooreHannah Moore ston HH 017045My COMMISs+on HH01',,9a wEap,res07.ai20?a1/202d
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building& Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
Ehman Electrical Contractor,LLC _ have agreed to be
(Company Narnelindividual Name)
the Electrical _ Sub-contractor for Adams Homes of Northwest Florida,INC
(Type of Trade) (Primary Contractor)
For the project located at 3Ll)r 1)r �11i_. L,"�ir_
(Project Street Address or Property Tax ID h)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project,the Building and Codc Regttla►ion Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
CONTRACTOR St GNAT(RE IQualifieri S[R-CONTRACTOR SIGNATURE(Quabrier)
W Bryan Adams Timothy L Ehman
PRINT NAME — — — P1U\TNA%IE F
29179 _ _ 31748
CO['NTY CERTIFICATION At'.N1BER_ COL�'Tl'CERTIFICATION i�[318ER {
State or Florida,County or St Lucie State of Florida.County or ST LUCIE i
The roregoing instrument nas signed berore mr this I day of The foregoing iustrumeol was signed before me Ibis dai of
20 "! W. Bryan Adams 204.lrby Timoth�l L Ehman
- -
srho is personally known Y, or has produced a who is Personally(mown.J-or has produced a
as id tireeatlon as idenllilta ion.
STAMP STA%1P
51 at orN r- v lic Signature ors\Diary P blir
i
P I n's�me or-''- q Public ,��NIIIIHI !!/!!� PAte2mtor�Ko�lj:iryFubblic ;
S rAZFrvk,., i
: �G�yGR 2,1 dl
orw*eL Nalary Public State of Florida ;
_* r Laura Townsend r
••y My Commission
Revised 11 16 2016 ;* y MR 175436
v 10077 S 40+�0 Exp.911312025
.+'.
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