HomeMy WebLinkAboutChange of Sub-Contractor - Electrical PLANNING & DEVFLOPINIENT SERVICES
J - BUILDING chic ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR.SUBCONTRACTOR OR CANCELLATION OF PERMT
YI.EASf.Si;LCt'T OW Q1.-Tii c) Iv w iNC;:
C14ANGE OF CONTRACTOR—Change of Contractor is io be Signed sine!notarized by the property owner.
and the new contractor of record for the current permit A new permit application must also be completer) %vith new
contractor information and signature. A new Notice of Commencement mum be tiled in the new contractor's name
for job values greater than $2,500 (S7,500 if A:(' Change-out). A recorded cop)' inust be submitted prior to
cotmmcncing any work.There is a$50.00 fee for the Change of Contractor.
x CRANGL OF SUBCONTRACTOR-• Stibcont'ractor changes are,to be completed by the general contractoi.
The new subcontr-actor must Fill out a Subcontractor Agreement Form. There is a $50.00 Pee for the Change of Sub-
Cotitractor.
CANCEI.I,Al ION 01, 1'1s10111 — '1 11C CRIICC11.96,711 of a 1121ta1'l ri acceptable only' it no %kud, hit',hCen.d0il4.
Cancellation of permit 1> to be Signet) and notarved by both the owner and gUalifier of record. There is no fee for
cancellation of the permit.
Date: dL Permit Number: 21-U
Site Address:
. -.-. � L((✓. -- State
Original GC,subcontr;,clor or owner.limlder
3049
New OC,stibcontraChlt
Reason !'ur canicllatiorl
The undersigned does her.by agree to indem-ndy;ind hold h3rniless St Lucie County,its officer;,aget:t_s and cmployces front all
costs,fees or danli?rS HI'IsIIt, from ffily and aft CIA115 of action Cot any rcasun,m hich niby most:as a resutt of thus dumg:of
etvlH+�c.f�rr�ubrusltlsctur or c-ancell'i11011 or ikrmit A permit cannot be caned ed if ivorlc has been performed.
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Sign Hite or Noun, Date StgmAiurcut Iltltrry Date
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=Pub(tete State d F jondac 51ate or Fiar,QaMooreMoore sjbn HH 01709,sion HH pt'n9b1r10211r202<
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
•
Building& Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
Ehman Electrical Contractor,LLC have agreed to be
(Company Namellndividual Name)
the Electrical Sub-contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) 1 (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) $t'p•C0NrRACT0R CNATURE(Quasirier)
W Bryan Adams Timothy L Ehman
FRINT NAME w� -- - PRI.\TNA%lt "
29179 31748
COt'INTY CERTIFICATIOt NUMBER ' ' COl=N'TV CERTIFICATION[NEINIBER
State of Florida,County or St Luce Statr of Florida,County or ST LUCIE
The foregoing instrument%tiros signed before me this _day of The foregoing instrument was signed before me Ibis day of
W. Bryan Adams �r"12,.20.)4by. Timothy L Ehman
.. ,._.
r bo is personally known.#, or has Produced a who is personal}known X or has produced■ _
i
as id tiricstioa. as ldeatttica lom
STAMP STAMP
si waNN r lit Siglalurt Of i►0tery P blk � o
Syr vn
t NMI off+ n Public Print Name or Notary fPPubi1ir
k
l
? ?Qs, N; oW"&, Notary Public State of Florida
* ; : Laura "Townsend i
•.y — My Commission I
Reatsed It.I1t.�1016 2••o Ai{i{)g6fn '*= * tiN 176435
Z p , Exp.9113/2025
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