HomeMy WebLinkAboutChange of Sub-Contractor - Electrical PLANNING & .DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
- F OR'I' PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
YL ASf_�t'.LtCI } LN= (ll' Its, fcl )LI„C1w�l!�c;:
CHANGE OF CONTRACTOR—C•hancge of Contractor is to be signed and notarised by the property owitier,
and the nett contractor ot'recorrl fur the current permit A Ilea permit ahltticatinn mart also be CoitipletCCl «-ith ncu•
conractor informatimi and signature. A ncu- Notice. of Commencement Timm be tiled In the new contractor', name
for Job valucs gresler than $2,500 (57.500 if AIC Change-out). A recorded copy must be submitted prior to
cotmiwvicin, arty work.There is a $50,00 fee for the C liinge or Contractor.
x CHANGE OF SUBCON1 RACTOR -- Subc(mtractot changer tire,to bit compl;lned by tl,e generid contractor,
The new subcontractor must fill out a Subcoimuctor Agreement Form. There is a SSO.00 fee for the Chan;e of Sub-
Contractor.
_ C:ANCF;1,l.ATION OF PLICN117 — I lie cancellacim ofri pernt{t is tcccptuble only it no work has bccn do1w.
(`aricellition of Permit is to be <igncd and noiarl2ed by bo!h (lie oicncr and qualifier ofrecord, There is no fee for
cancellation of the permit.
Date: _ _ L` � — — - — Permit Number: [S
Site Adclrc5s: 5-3, �7_A(.—
Original GC,stibcontractot orit�snei'1,Itil,icr
TAW t ,l�� �` t _st:3t 1_a�.�n;e - iL7SU' Liccil 3049
New GC:,suhi imi-, or
Re-ztwii fur Claiwellm'1011 ---
1 h0 tmdcrsigiled dales I[errby a,urcc in inde;u;lrl�y thief IwIttWrmless fit Lute Coamy.its offiecrs.a.get,ts and cmplayees frmnl Al
GUSI`,fate,,O[`dri7wh" Ci 86511%f 0elt 9r[) AFrii h11 tlrl�tlli ttf,lCfTf}Z7 h]r [IY rod$(}6e \C}LtGlt rt1II} AR'yC 1S;I !'filll!Ui Jhiti ell:[ll�C UI'
.,,ttF:Ir.t,t+�Fib+Ci,rl r�cise( of cutIC{'HM10ii p:permi A permit caurror he cancel ed if work has bean performed,
Ste.!�ltl'Rt f3J 011'r,i..R 1i+, l)q,ilildY} SN:r1�_+i1IJt2E rE�/E COS rk.\t'ri k rnat,{;t, ��ap(,JK,�b=.l
+`'tU:1' i. t:C �_...._�_ +'E#FV� N�+o-4E —t Lei-�`
=art r,i f`ta n1u,iarFnry nt�[ Lt 'c 'en.ctt .riot,oft'al%era Cat,1 ty of Se 111,iC C{+u:ty
I IIr:f il,:c[[^1 1-[,;.-_1::-:i A:1,...n .f..9:*1-:n14-Lrv-r:AYt 41ki, rI c ro{]nt�c�3,ua tr.n trl ti:r: ,k:,wig#;rd b±r-re n.t 4hr,
;•r rv' ,t.+,profit c'._ _ss i:} [ ; : a ua,rr ld-ALed
q MUD.
Sf n lure of Nnran nose S( nMfnrCor'NOta Parr
F Ji r7
ar'4, Notary Vuat�c State or Ftpr da
=0/'O?/2024
State or F,4a :° k Hannah E MooreMoore . My C-;nn. scion HH 0+70Wan HH Q t 7 9y ��a n EIP res 07+01Y1024t2024
E
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
•UNT
Building & Code Compliance Division
- BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
Ehman Electrical Contractor,LLC ` _ have agreed to be
(Company Name..'tndividual Name)
the Electrical __ Sub-contractor for Adams Homes of Northwest Florida,INC
(Type of Trade) (Primary Contractor)
For the project located at_ a k fL j G�—
(Project Street Address or Property Tax ID 11)
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 tQualifierl St R-CONTRACTOR SIGNATURE(Qualifier)
W Bryan Adams Timothy L Ehman
FR1N'T KAhIE -- PRINT NAUE ' ,
29179 31748
C01'NTY CERTIFICATION Nt'318ERM o"RTV-CERTIFICATION Nt-1[BER
Stale of Florida,Counh'of St Lucie Stairof Florida,Craoty of ST LUCIE ,
The foregoing insrrumttit„as sigard before me this I day of The fgregolag inorumear was signed before me Ibis { dar of
W. Bryan Adams f"'brlmcl`I— .2D2.L by Timothy L Ehman
srbo is personally known)� or has produced o who is personaly known Y--or has produced a
as id tificasion es idrntitica Ion.
y+j.�+ STAMP STAMP 1
Si at af'NN r- u Sir Signalure ar�'arary P blir
P 1 Name of N r)Public \N1�1Nti111HIh7oil f Print Name orr\ot,ry Pu61ic
Sp,RA S7,, J�i��� r
•oauassiay.
y6 EtGH2)� o•.
�`'a�n o+l+"� Notary Public Stale of Florida f
t-aura Townsend r
• ►•� � ,; � om
R My
cvised I1.16-20t6 '*S �' ' HHC 17543$5miaslon
r
p .p u1100177 y �o;n Exp.W1312025
.i d ePolar
.q he+c rider; �P I
STATE&
11O
IfI11H