HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & .DEVELOPMENT SERVICES
'COUNTYBUILDING & ZONfNG DIVISION
2300 NIRGINIA AVE
FORT' PIERCE, VL 34982
(772) 462-1553 FAX 462-1578
U
YLCASL S[:LCC") U ) I"r l={)Li. 1k'I.tyCi:
—CHANGE OP CONTRACTOR - Change of C'ont+acror is to be. signed sand norarizcc!
and the nc!%% contractor t11"rccorcl for the Ctlrt'ent permit. A r1eH
by tile Property owner.
for
rnfS ty run ind,ignartrrc. A iiew Notice of t'ummePei'" c:nr mttw be filed in [lie new molted :I name
permlf ap!)ticatiot,l mrr5t aleo be conlpietcd u'I[h ncla
colilta
f'or Job t aiues greaser Phan $2,500 [S i.SU(1 if A C' Ch�rnge-out). A recorded copy must be suhn)itte
corrutiencirrR any work. Thcr[ is a $50.00 fee for the ['lannge of Carrtractor"
d prior tc)
X CHANGE 01 SUBCONTRAC-1.Olt - Subcontractor changes are to lie con]ltickd h}. the rrenera
Tile new subeantrraetor mutt fill out a Subcontractor A�,reenunt Form. There is a SSp,Op fee for
Contractor, {�ntractor.
the Change of Stril-
('ANC FI.I„A'1lOr� 01 !'1,1t,\�17 fire CNr1Cc'tf8riiln Ofit permit rs 30ceptabre only it rto %vork h is bee„ done -
cancellation
of pernrit r. IO be .sigrictl crud n0LIrved by both tilt ottiner ar)d grraliFier of record. 'There is no
cancellation ofthe permit,
fee for
Date: _ —
Permit lVtrtttber: _al-a�
Site .Address; -
(:
Orf mai c State t,.icrrlsc
t u);rl r(; , subconuacrol' or t)�titier knri[r1c1 (, !"C 1. ic.ctnse
Nc,,r (iC'. Sube.onu;rrlr)r —Slate
LC
.. Sl..iccn.c
Re.aso+l fur C'1tnrcli rnort
"1 lie undersigned fines lrt rib} agree in irtdent,7ily ;rod hold fttrmless St L o � olfic �
C081ti, f0c� UI" d;llf,,1`-�> afiSin lrUrlt nny arrd Ftli Ci 1r1113 r1t uc`tirin t;)r arly Lucie
which Its o rl iw leis, c.re;u[r of f1tiplchcut r frnrrr a[i
rt'tlilac.t�t';ubcurtclacrur ur canrclluhon of penntt A permit cannot lit. erneei rd if lvork li3s been perforrned.
gt nI"
_� _ _�
tiK ti°Arl'R! [fr" U11r,Vi:.R {r+r t_Zle. burldat•j
StC,NI](WE GENE f,'rl\'IR.1("r17(t to = t< '
r"Ri:ir' r•=,h_G � . } ap{rfie�b�,•1
r'itr 'I N AkIE-,-vJ&- t
S,au of t°iortds, o[Irurrp,lF $t Ltlt c Cou,a1' -- U&1� "
iie'411Al'{111 Iq(14'11r'grl n;l..t ulcr•.t` 4 1!;al I,, ford ntr Ilu:
w��. �_i 17 �5*!,rtlStF[1t011A11 i
���ti1tr�
5�...nt{tt IW C r
k lrc of Notary
ter f�C, ��uClrc Slate or F10,.da
Hannah E Moore
�j' pY MY Commus40n HH 01 ),19.,
�� W nd� E ,p red OlrO, r202a
Sln-. e(Ftarirn { aw:t/ of Sr. Lucie C o,l •ty
rrf: r;,r)NV3 to r nl,'w om J L
3, I�::11141.""ged bei 1 1
�t�LLrr„/ fir} i,y�Y re rrc F
. l+rrsnrl�lly I.twxTl tr,
i f Wt71}rliliR 4111Ca"�+rT,�'j� da tt) .�-�
Sll{rtntnrc(if Nntat) Uart'
=Exp�,res07.,01r202-d
slam d F_ 0aoore10n HH 017099r202d
PERMIT It 1 1 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
Ehman Electrical Contractor, LLC
(Company Namelindividuai Name)
the Electdcat
(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 ff _414141 LLC
(Project Street Address or ProPertyTax 1t7 {i)
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 t3E IQualferj
W Bryan Adams
PRINT NAME
29179
COt'NT1' CERTIFICATION N(,%I ER
State of Florida, Count) of St Lucie
The foregoiRS instrument w as stord before me this I
20 Z b) W. Bryan Adams
who is personally known Y, or has produced a
as idybliricadom
Revised 11. 16.•2016
day of
STAIIP
St A•CONTRACTOR SfcNATURE (Qualirrer)
Timothy L Ehman
PRI\T PKAUE
_ 31748
COL NT1' CERTIFICATION Nh1iBER — -
Sutr of Florida, County of ST LUCIE
The roregolog itarrumeol was signed before me Ibis dar of
..,20 Eby TimothL/ L: Ehman
who is personally known X or has produced a _
as IdeallAceilon.
STAMP
SlEaalure of Notary P bile
'AM
Priol Name of Nolary Puhlie
dim oft
=ov►at' Notary Public Stale of Florida
Laura Townsend
My Commission
M1 HH 175435
Gy E x p. 911312025