HomeMy WebLinkAboutCHANGE OF CONTRACTORCOUNTY . }
F L 0 R 1 D irl o
PLANNIlNG & .DEVELORMENT SERVICE S
BUILDING & ZONfNG DIVISION
2300 VIRGINIA AVE
FOR•I' PIERCE, FL 34982
(772) 462-1553 FAX 462-I578
PLEASE -4LLC 11 '1i' fOLI= _1� IEYU:
CHANGE OF C:ONTI2ACTOR — lunge of Contractor is to be sig;ied and notarized by the property Owner.
and flit' nc'N COntt'ai'Inl [)I E'Cl-Or'd tUf lily C.
contractor information and signattirc. A im", Notice oeilt tf" C.'oni encenienerillit l lmc�u Ibe tfiled in It! a Inew Col. �ttt! p� v
tur job t alucs ,realer than $2,500 (57.500 if A.T' Chiinge-out). A recorded copy must be submitted
commencing any work. There is a $50.00 fee fnr the Cit:tnge of Contractor. ors ,11 to
x prior to
( 1ANG)Ea Ol SUBCONTRACT012 — Subcontractor changes are to Ilr• c0111leted by the �,
Co new subcctntractor must tilt out a Subcontractor A��reernant Form, There is a $50.00 frc for the Change Contractor,
p ' ,eneral contractor,
be of Sub -
(:ion L)f el-Illit IOt OF 1'rnctl 1T — [ lie cancelfar,on of a permit rS acceptable only it no %vurk has bccn dcprpc.
Sub -
Cancellation of ipermit r: to be .�tLrite,j ;utd rn�tarprcd ip} both the otrnt r and qualifier Ofrecord. There is a fee for
Date:
—�- Permit Number:
Site Addt-ess•
'� . r f�
Urft;i- _ --�_
(� State Licen.c rL Qv
nnl G(-., subcontru'lor or (M'l:i itllfer ( f-C' l..ir+:nsc
New C1C'• 5ttbcc,nrl:tcl[pr f-.icenseV 4, C�
��SL(' i.,iccnu
Reason fur C'a1l"ellativn
-fir-
1 flc urpdcrsigncd dncs her-6 aur-ee ro irtdc'nrpify a[td h")Id harntics,S St Luc! ['o� officer: a.L'cr
c{rSts, fees or drirrap r s 8rla+nL1ior+1 Any loci al{ cl;tr'np3 rt,factinn f,7r any reason, %rthrcti nlay itris as .t rc�rll[ ut EJtis cfurngr t,t
cintr r t,]r�subCurrtr ��tut or rl-rrcllailon o; ph ?yeas frtsrtt,l!l
1pe.rnut A perrnif crurrpot he cancel ed if ►turf: has been Performed.
SIC,'VrlwilL(,I-ou,Vi �� -r.erbuiErf�.r[
SlCFr�,•I] uuE G�Nt: C'C)�,� �p+,�t=rnft for n«< r;i. .
3 A ({iT PI:,FiG r j. ns apt�lic 1b�.•l
S,nis or rhi,I&I. <WUF[ f
S' $I E,IrCr. i�Mlr.[t
The tJlEpxtnr_ 1n,[r.�n•:_u ":±, .rci�l,�.ac lxe.l htrtrrc r±s[ obi,
-
w rA
4-1 {xrrzarsllS Lr�li.p, �6 uk
rT
SI aI
$ Ire or rlorary Ilatr
E10,P
"- rYiPubiM State or Fonda
Hannah E Moore
yMY COMM'Sr,on HH 01709y' E■prree0110?rZ024
�tdlC ptf'Jq(li'y Collidj Ur$I, U,w(cuity
�4 lotl�t.r:ig u,.trurtrrnt ,sa;.:.;;
�' Tl�, L rni'redgcd bet;,rr r-ic r�.�,
r L: f wE,[FtWi r lJ L -
r uc4
Sr rwturc
>t of 4ntur�' Unrc
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',c Slate of Flori69 Moore�S. t�H o17o9Sr71r2024
PERMIT # f I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Ehman Electrical Contractor, LLC have agreed to be
(Company NarneIndividual Name) w` the _ Etectllcal _ Sub -contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) — - ' (Primary Contractor)
For the project located at _ a L
(Project Street Address or Prope 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
ding of a Change of Sub -contractor notice.
CONTRACTOR SIG,NATt RE (Qualified
W Bryan Adams
PRINTNAhfE
29179
CGUNT1' CERTIFICATIOr n(,1(gER
State of Florida, County of St Lucia
The foregoing insl►nment mis signed before mr ibis day of
2g21;bi W. Bryan Adams
who is personally known t or his prodoced a
STAMP
Revised 11-16-2016
SL a•CONTRACrOR SIGNATURE (Qualifier)
Timothy L Ehman
PRINT NAW
31748
COV.NT1' CERTIFICATION nt'�IBER
Starr or Florida, County of ST LUCIE
The foregoing instrumtot was signed before me this-.. d clay of
29j4). Timothy L Ehman
who is personalh known X or has produced a
as idenlifles ion.
STAMP
Signattuyr�e,orrNarary^PP bile
IQ! 1
Print Name of Nelary Public
M
Notary Public State of FloridaLaura TownsendYmy CommissionHH 175435Exp.911312025