HomeMy WebLinkAboutCHANGE OF CONTRACTORCOUNTY L ,
f f, 0 R I p A
Nr. sE Ur CONT
PLANNING & .DEVELOPIMENT SER1,10E S
BUILDIkvr
1 & zoNfNG DIVISION
2300 VIRGINIA -A VE
FORTPIERCE, FL 349,32
(772) 462-1553 FAX 462-1578
NCE�ION O
YLLASL &,.LC('T Cl L U! l ti PULL y�ra:
—CHANGE OF CON. "URACTOR — Change of 1701111aetor is to be Signet{ and norahzed b) the property
and the nc►v contractor ol'rccord tot fhc current permit. A newpernnl application must also be contpleledowner-,
contractor information and signature. A aca. Notice. of C'omntencement must be filed to the new contractor's name
tl with nest, for job �iiiues greater than $2,500 (S7.500 if Ai(' Change -out} .A recorded co
colttlttencing any work. There is a $50,00 fee for the Change nfC'antracrar. copy must be submitted
X prior to
—C IJANGE Ol" SUBCON7RAC FOR --'.LtbcOtltJ'aC(or change a Ire to be f orn !t ttd hp the
The rae Subcontractor ntt[;t till out a Subcottztartor A�,rcement Form. There is a SS0,00 fee for the Chan
Contractor.
p geneml contracted.
,e of Sub-
- 7��'C F,LL,�T )O+� U}. !')IZ\117' - 'Cltc cance[iarurrt of a f�cttil t is acccptabfc only it no tt'ork httti hrcn clt,nc.
('a n; cllatitin � f permit [. to be signet; :mil noiarued by both the ot�ncl :end qualifier Of'record. 7`h
cancellation of the pel tail.
ere is no fee for
Date: — --42 b
Permit Number
Site Address:
Original ' - Stale Uc cne
or CL av ,
(.i(', subcon[rata4r u%tineljluihfer - — �
1.(� I..it:crtse
New C;C', �uite.onu:ICtll[' � St�ttc•, l..rccR.;e L(.. L,rccrr;e � ���
Reason Iur Can.cllanorr _
3 ftc undrrsis•r,�a ,f:, _. r..,_ ate-- .. ! S rtiJ
-v ,t, nlnetimriy atld flold harmless St Lucie C'outtty, its iillofliccrs, agents and cmptlr} ees train Allcosts, fees or danvig,.-S arising rmm rtnyr (l ,tl, cl timf n arti ct,nfr 1cWr'subcuftrracrttr ur caulcellallan of i .Anil A permit ce+root be correct ed if tt
> rtn Fltr any reasoe, whlctr rzr:t}';rrise as a resrllt of fltis clr,rngr trl•
oil: llas been performed.
Sk"AFUJIL fr[' Utl�Vi:R tar ,,urer'buihl�:�'t
j' /� SI iNrAkI UftE (iEV ..
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+'RiVlt' ti=,h;G J ae applir:+b Cl
`rbtt or 17IU8jila. C NIrtly 4i1 Sr I.JJC1, io,n:n:
The tollo
+u•irl ul;n:nr,r;:r u;r;,r a,; ,,rca,nl b:ri+r; m tllr;
17
:ts ID.
KM-47-
Sfgn lure nfiYer�„ti rate -
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uDhc Slate of FW.dah Moorem.sston HH 011J9S07+01f2024
11ar_' PI l td9.(Id, t'0urry r,f sl. I.1kIC c(tw y
r1cf.7t1[r "ago, fru�nn.r,ru.baa,i uu'rsd,cdbtti,rcr,c!Fi
daynt 1 k"- 4 i 1
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- S� �.,h r: I�rsr•rll} l rgie7, (�,
r c who?i;,R u(ed 3'11)_
S(gnmureorNotary y lr� urn V
cop tyk Notary Puwl. Stale Of Fir.--OaHannah E Moore
My C..nm,sson HH01 AL
'?«sir E.p,res 07.'01r1024
PERMIT 0 ! 1 ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Ehman Electrical Contractor, LLC have agreed to be
(Company Nametind ividual Name)
the _ Elecidcal _ Sub -contractor For Adams Homes of Northwest Florida, INC
(Type of Trade) (Primary Contractor)
For the project located at _ LLBe l-) ;.
(Project Street Address or Property T D If)
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 SIGNAT( RE (Qualified
W Bryan Adams
PRiN-F NAME
29179
COc'NT1' CERTIFICATION N7c� *1 EER—
State or Florida, County or St Lucie
The rore941ug instrument tt as signed before me this L day of
Fib .20 Xe) W. Bryan Adams
who is personnryy known )L,or has produced a
ss idnlifcealiaa. i
STAIIP
..
Revised 11 16.2016 S o: y yE
. o 106177
y
��••f".o yard �� v��+: •�Or��
�i oblit Uads ' ?;
fSiATE1�o�`
IIIlttttl�
St R.CONTRACTOR SIGNATURE (Qualifier)
Timothy L Ehman
PRI\T NAME
_31748 _
COL'WTYCEhT FIi AkrI0,!Nf_t8ER
State or Florida, County or ST LUCIE
The foregolag instrument was signed before me Ibis dat of
)Z6n4ZZ ). , 2 z;.by lmotgy L Ehman
who is personall known X or has produced a
as identifies ion.
STAW
Sigaelure of tVotary P hlit
Priai Name of notary Public
oo'e' Notary Public State or Florida
+ Laura Townsend
M H1on
K 176435
.�0P Exp.911312026