HomeMy WebLinkAboutCHANGE OF CONTRACTOR- J, _. PLANNING & .DEVELOPMENT SERVICE S
• BUILDING & ZONING DIVISIOti
2300 VIRGINIA AVE
FORT NERCE, PL 34982
(772) 462-1553 FAX 4b2.1578
CHANGE' Ur C C?iVTRAC�'OR SUBCONTRACTOR OR CANCI;LLATIOLOF pERM T
CHANGE OF CONTRACTOR -- C'hange of Cotractor is to be signcct and nt�rarircd b nc�
and the new contractor of'rcc t}rd for fhc cCLrrenf perttli+. A nex permit apphcatiorl moist also I>c C0111Plelc(lrwlty owicti�
contractor infarmalion and signature. A lie" Notice of t'ornrllericemcnt rnwst be filed in [lie new Contractor's narilC
for job laitles greater than 52,500 (57,500 if A.T' Change-oltt)A recorded cagy must be Submits
C0111MCI1CIn€ arty work. There is it $50,00 fee for the Change of C'outl actor.
X Submitted poor to
CliirlNGfa OF SUBCON7 RACi'O11 -- Subcontractor cha11gcs are to be cot11lileted ily the !;eneraf rontrac
The new subcon[lactar mutt till out a Subcon(ractor' AFII'Cenlcnt Form. There is a 550.00 fee for the Chance
Contractor, to+•
,e of Sub-
- anion of p t-n,it UN 01' 1'l;R1117 — "t tic• carlcelfarlon ofa perulri is accc.l,tab!c only it no %�•ork has becii clone
canoel atioll of hermit I. to be stl nt d and n��rari�rd E,} both the ati�ncr raced cjtralificr of record. The
cancellation of tlic permit,
There is no fee for
Date: _ _ . IL/�,�.. Permit Nun>;her: "
Site .Address:
(1rfl;iu,tf (:r{;, strlycontrar.lor or itstiticrl,srrllfl r - - Stale Licc nsc �L c
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Reaso,l I'ur C':utccllation
7lit uriifcrsil;rlcd fines hereby aui-ee In ind:uuiify and hr�ld tlarnilaS& St LuT ie [' ln� ulficcr,
costs, Inc.; Or d�tilt�,�" at i;in� ftort[ Wkn and al, claim, c,f al rinn fo[ tatty rrast,n, i�tl;eb n[ ►}. alix as it neiult of this oyck r tkf
c•a11UUeWr :ubwI1 tctar or rulcellatwn of l,ersts n.rsd cmpftiycks from alf
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Ivitnit A perm[! ctrrlrlot !rr cancel ed if worfc has been performed.
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stgrratureofNotur). Dale�
+a . Notary Public State al Flor,da
Hannah f Moore
¢ ' MY ", tFrc Mon HH 0 t 7099
'►a n E■p,res 07 OII2024
PERMIT 0 1 1 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Cade Compliance Division
Ehman Electrical Contractor, LLC
(Company Namelindividual Name)
the _ Electrical
(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 X
(Project Street Address orP- perty T I Ft)
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.
6NTRACTOR SIGNAT( RE (Quatitierl St B•COVTRACTOR SIGNATURE (Qu�.lirier)
W Bryan Adams _ _ Timothy L Ehman
PRINT NAME _ PRIWINAWE -"--"-
29179 31748
COUNTY CERTIFICATION N i18ER_ COl \T1' CERTIFICATION N['hIBER�
State of Florida, Couvty of St Lucie ST LUCIE
/ State of Florida. County or
The foregoing instrument a as signrd before me this { _ day of The foregoing instrumenl was signed before me this rla) of
kG�jnc� ZO 7rb) W. Bryan Adams
t'L fir .., 20 ,}I. Timothy L Ehman__ _
who is personally known ' or has produced a who is personaly known X—or has produced a
J
catioa as idrorifita Ion
STAMP STAMP
N r tic Slgnslare erNotelry l? bile —
iv 4 Puhlir t,►Illllif►f7fj �aLiQ IQyI
SSA STj44 111k, Feint name of notary Public
Wx'
Notary Public State of Florida
Laura Townsend
Revised I1 Ibr201fi : * ? My Commission
'M06177 N 175135
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