HomeMy WebLinkAboutCHNAGE OF CONTRACTORUUNTY
F L O R I D A'
NGL OF
PLANNING & DEVELOpiNIENT SERVICES
BUILDIN['
y & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCL, FL 349,82
(772) 462-1553
FAX 462-I578
CANC
PLEAS!: tiI:LECT f}NL�i 1�c]Ll n1� INC;:
—CHANGE OF CONTRACTOR - Grange of Contt.'rct,r is t0 l,e- signed arld notariie(f by the Property
and rite 01- i rormactol,tion ind cordsin fur the c c,*%, tl permit A neµ permit 2t�phcatiOn roust atsa be eprlrpleted «ith ncc
fk)r joblor information nnd;ianature. A uc,� Notice. of ('ur�,nlencenrent mast be filed in the new 111 let0d rt�owner,
for job tahtes greater that, $2,500 (57.500 if AX Chrnlge-out} #recorded copy must be submitted �
CQtlilllc:IlCtnn nan,C
arty work. Thera is a $50,00 fee for the Change of Contractor.
pnor to
�C'IiANGE Ol Sl'BCON1'RACCO1t - Subcontractor changes are t(� be cotltl,leted by the �rener.Il r
The nc,v subearttraetor nxrst till out a Subcontractor A-�r•cement Form. There is a SSO.Ob fee for the Chanoe
Contrael0r. :� untractnr.
a Of Sub
C'ANCF,I, -Illil N 01 PIKE{.b117 - 7 hr cr►nccflariorr of tt perltut rs accaptablc only it n0 uork hati bcr,r dctnc.
Cancellation anon of itern,it t: to Lie stgncti and'lotan7cd by Loth the o,incr and qualifier r,f record. 'There is no fee For
Date: _ _ h
Permit Number: `kL
Sire .Address
Urtl;intll GC, s,rbcontraclor or cittincnln kr - - State License �G13gvs l�
I -C I.. icense
Nf',v (:;C'• 5tnc�0tttt:tClt,r Alk- -State I iceme
---�� — LC I..iccn:c 30i f
T
Reason !lit C:rlt�cll3rton _.�
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costs, fees (I r drtrtta8Cs ariarrg >r,rr,r:xtq tcrrlltnl; 11irm Jct)f tdctc rntr'eil a� ylicit
ti„Lo s h k�tylancr� - i ILS and this IchanS,fr»m :all
c�ntract�,rsubwnuactor (or c r,trcll�ttloli o: Ikrrntr A pcl-mft Cnrtnat !rt c�ncet edit work tan been perfornted,
ig I
sir;��tn°tzrrn=ou+�f.Rin,;;w�,trt�ullril��j ._ �_�
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1
�.urr ui f'tlmrdo, tCIO Oil )' of Jr Eht;c 1.-ehaen
The ;{7;rJli'r4_� Lr14t1atl'Ctd u:M ,,,:i;,h+.: .
oh , ra j'[rLOn3 I) 4nU nt l nr.
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a4fr
re of hl4fary t,arf
A, y 7�u01 - Stare of F orHOa
Hannah E Moore
4an�• fMY Commles,on ► H 0 r 7095
E■Poree07rOrr2024
lr art of [leech. [ uur,ry ortir- Ix%,c cm.lry
rI C 1J(Inkt.,g us nnnrr ua
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Stljrtarure of Notary — � h
are
=ME
c Stare of F;r -jaDorcY
,on NH Ot:'.,9r,R024
PERMIT!! ISSUE DATE
J_ I
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB CONTRACTOR AGREEMENT
5hman Electrical Contractor, LLC _ have agreed to be
(Company Namerindividuai Name) the _ Electrical _ Sub -contractor for Adams Homes of Northwest Florida, INC
(Type ofirade) —Y—� (Primary Contractor)
For the project located at 5� Mo LLzr°
(Project Street Address or Property ID
1D r!)
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.
5 CONTRACTOR SIGNATt'8E iQu� rl
W Bryan Adams
PRN—r NAME
29179
COUNTY CERTIFICATION NUMBER
State of Florida, County of St Lucie }
The foregoing instrument »as signed before me this r day of
Fry , 2a 4 bf W, Bryan Adams
%Yho is personally known Y,, or has produced a
as id tiricatiaa"
Si at o N r -. fie
W- '
P INameorn r) Public `�1ti11H1H1►I�rf�
Rovised 11' 16:2016
`5
St &CONTRACTOR SIGNATURE (Qualifier)
Timothy L Ehman
PRI\T,\A%IE
31748 __
COVINTY CERTIFICATION 11'V,\IBER
Stare or Florida. Countyar ST LUCIE
The foregaing instrument was signed befort me this ( dal of
f4Wk'cr.2 ,b) lmothy L Ehman-
who is personall known Y- or has produced a
as Ideatiflca ion.
STAMP
Slgaature orNotary P bile —
.� .•o;,alassroy' Fy �'4
' G GIi 1) Fto' i
S
O' Yi106 77
:'•1 ad try tea`,. r
/ am—��Sf�
Print name of notary Public
�,r*r'ry (votary Public State of Florida
`h Laura Townsend
K My Commission
Qlf., Hit 175435
ow Exp. 9113/2025
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