HomeMy WebLinkAboutCHANGE OF CONTRACTOR (2)COUNTY
F L 0 R
r
PLANNING & DEVELOPMENT SERVICES
Bill, ll1NG
& ZO1NIl11'G DIVISION
2300 VIRGINIA AVE
FORT I'1ERCE, FL 34987
(772) 462A S53
H
FAX 462-1578
�t<xsr� ,5ri1LCCT_r,r�r� c�x�Iri - r(�L�_ ►�'Ivr�:
—CHANGE OF CONTRACTOR — Change of Cnntrat�tor is to be signed and notarized b • r )
and the new contimcior ol,rceprri fur the curretti permit. A new
contractor information and;ignnturc. A nc", Noticr. of C'um(ncncentcnt nuutit be filed in the new nlplett�erty owner,
p.rmil a11)litation mutt also be cantpleted with now
for job talues greater than $2,5?)0 (S7,500 if A.C' Change -out). A recorded c()
canut)eitcin+* y )Gactor's name
�, an work. There is a $50,00 Fee for the Change or Contractor,
pti must be submitted prior to
x CHANGE 0 SUBCUNTRAC I()lZ -• Subcontractt)r Cfl�tt�t`5 ilfty IO VC { pnl�tlet2d by the general
The new s>rbeonU�ctor mast fill otil a Subcunuautor A�treen)ant Form. There is s $50.00 fee for the Chngo
Contractor. contraCtal,
change of Sub -
The e)F 1'1 12+\117- — .1,Ile cancelfar+,art of a perrtut rs aeteptable only it ntt „vork has been dune.
('arice[tat ion of Perrnit r, to be signuel ;Ind notarized by both the o�4ncr and qualifier Ofrecord. There is no
cancellation of the permit,
fee for
Date: _
Permit Number: _�1•
Site A(ldress;
(1rl9111111 (;C, subconuaulor or tnvner lurildcr Y _ St:ttc I -icen c
License
New-fJX (rC'• 5tthegnu.tcl[)r faCW.- _State 1 icense�C_ 1 S L C 1.1Ccn.se �
Reason fua C:ulrcllstion
'i he undersigned does 11 rrb� aga-CC to irtdett[aily and he)jd i}3rntleSS St Lucie COt1gEy, ullicCr,
costs, fees or do-etttn �s axis+roL; ft[N+r any :rod a1t cl;ain), rtructiCtn rbt- ally reason, 1YhtCtt nt (}' t[�,e as :I rc sr(Ir of t✓?ia')YCO r trt
.t>;cr:tc and cmpte)yee;s from ,ill
�i�n[I c!C(JI'rS[II)(;Unn:1C tU[ eat catnucllatton of l IUM A permtt cannot t)c ranee! ed it worl: has been performed.
tK
.11G,4"I.,RL'rrr"pµ'Vi:R' ju�eiµq;�rbuild�:rj
Sit;r��,��CJEtEGl:V1: - 1-
'; NT U.-,KE �� ,C Cn`rrrAC•T•Qkternc«Yf��'.oea I.;
r UNI NAkJE-.�Imath� .
S,ule ui fronil:r_ ltxigt•' of " �'•-� ._
� SI Cottle C'hrlr.n
rn::otl,,uri:_> sour+: �•u ,t:r.,
—
Si
jwwak,
(tire or Norary t)yfr
vf
Ze�Cfrt Stare W FI9r,oa
HannahE Moore
MY Commiaston HH 0 r 7o9y
�pr1% ERp+res07+0[r202a
1rA[: Of Pondi7. ('hurry of Sr- raa: p. C(litw/
r E�linsvt:i[ to [r[inrcrrl ubc aA thwltdp(d brlure me m i,
J day of / n6aL�
��" l+t+z,nall l.nben f{i
t o r Whit thd� prpJu,vd
S[�rutrurc of loran) Darr
CAOff
'err Notary Peplrt Stare or FlOnda
Hannah E Moore
- p` My Cammrss on HH 0 r 7045
1?o;Aer E%prresa?-ol/202a
PERMIT p 1 1 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance~ Division
Ehman Electrical Contractor, LLC
(Company Name.. Ind ividual Name)
the Electrical
(Type of Trade)
For the project located at
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for Adams Homes of Northwest Florida, INC
(Primary Contractor)
(Project Street Address or Property * ]D !t)
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
tiling of a Change of Sub -contractor notice.
CONTRACTOR SIGNAT( RE (Qualifierl St &CONTRACTOR SIGNATURE (QW;IJ;&r)
W Bryan Adams _ _ Timothy L Ehman
PRINT IYANIE PRRT NA %I E
29179 31.748 _
COt'NT%' CERTIFICATION Nt-AIBER------- — COta\Tl" CERTIFICATfON Nt,diBER ---'� --
State of Florida, County of St Lude ST LUCIE
Stage of Florida, CDLnty or
The foregoing instrument si as signed before me this day or The foregoing instrument Has signed before me this # day of
��hry 201.4h1 W. Bryan Adams .� Timy--oth L Eh RlGfZ/ ,20t by � . man ,. ._.
who is personally known Y= °r has prodaeed a who is personaI4 known X or has produced a _
as id tirecstioo- as Idenll6ce Ian.
STAMP STAMP
5+' o N r IC Slgnalttrt of Notary P `bfir �""
t,N ry Public +r111tlttFff/ri/1 �_—;'�= — L
Print dame or notary Publir
* ; �',rl"u, : ,e*'•+� Notary Public State of Florida
psi Laura Townsend
Re+, sed I I Itir20d6 — * 'r ` MyHH 17iC3tflon
x :z *'4 f
'� 06177 S ?°r^ Ex . 911312025
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