HomeMy WebLinkAboutCHANGE OF CONTRACTORPLANNING & .DEVELOPMENT SERVICES
COUNTY BUILDING & ZONING DIVISION
'_ ' 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-I578
CHANGE OF caNTR:SLC7•pk, SUBCONTRACT4It OR CANCCLLATIOI� OF PERh1T
PLL�SEL[Cl n
-CHANGE OF CpNT-12ACTpR -Change of Conrt.�rtnr is to be sigrted:rnc! notarized h . the r
and the or car)haCtoE of record for the cui'renl permit. A IlCW permit illTpliCation must also be coillpletecl
contractor infarrnation and signatul'c. A new Notice of C'omnlencemcnr n)usr be fifed in the new contractor[ owner•.
f'or job Valtics greater than $2,500 (ST500 if A;C Change-otti). A recorded co
Con1111"Ci19 nAtI1C
any work. There is u SSfl,DD fee for the C'h:tnge of C.'otrtt attar, pY tnusl be submitted prior to
x C11r1NGVr tll SUBCONTRACTOR - Subconts,actoi ehanKeti are [0 ire t01] 1�ted h}' the u
The new stlbcontt;tetor must till out a Suhconu"actor Agreement Form. There is a SSD.DO Fee for the Chan
Contractor.
P ' general contractor.
�e of Sub-
_a:ion of p I,,lit i$ t o of 1911cd41l - i he casrce rf;1r'0fI of a peril►rt is acceptable only if Ile) work has bc•: r� dark.
('ancellatit�n of pertt)it is to iTc sl��rlctl ;rod nr�rarizcd by bath the o�rncr and qualifier of record.. .
cancellation ofthL, permit.
IlYerc is no fee For
Da te: --/j -
— Permit Number,
Site Address:
Origin -.� t� -. St,i!tc Liccne t!L
n11GC:,subconttactorolaucr-11r1ildel.
he%v X', subconc►ucit)i
Reisprl furC7ln,:Cf13ti0II
Thr: uncicrsiIfrcrr TI, r,,.....1...
- =r,« ru nln:nu)rY'y and hold ilarnYleSs St Lucie County, its office r;, aScrlrs nor! cmf+L))nfts afl
CoSrr, fee; or cwltZt,:g ari;ing 1""tom any and art Cl,unTy ctf uctinn C01' ally rcaron, tti'hiclt n ay arise as a resuil cat Ibis thou of
- C{,1T1121GiJf��l1b(,'UirI1�.Eer{Ir t7r isEgl'l'traiton [Vilnit A pel•mit ciinirot [,tic cancer er! if work has been prrformed.
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Hannah E MooreMY Commission
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c SraW of FloridaMoores,on HH o 17096 112024
PERMIT#
COUNI-v ,f
7 L n FZ I
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Ehman Electrical Contractor, LLC
(Company Namellndividual Name)
the Electrical
(Type of Trade) _
For the project located at
have agreed to be
Sub -contractor for Adams Homes of Northwest Florida, INC
53St _ L1,
(Project Street Address or Property
(Primary Contractor)
ID I1)
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 SIGNATURE (Qualifier?
W Bryan Adams
PRINT NAME
29179
i:ot`Krl ce1zTIFItArion tic MISER -.-.-.
Slate of Fiarida. Count► of St Lucie
The foregoing ins lromenill assigned before me this
�Gl�rtc4 .20tt,b)-W. Bryan Adams
who is personally known !IL or has produced a
as idnliricstioa.
of
Revised I I.16.2016
St R.CONTRACTOR SIGNATURE (Qualifier)
Timothy L Ehman
PFU\T,1A41E
_ 31748
COt ;NTY CERTIFICATIo, l 05% ER
State of Florida, Couery of ST LUCIE
day of The foregoing instrument was signed before me this t day of
-...... a.fU4'`t.., 207 Eby Timoth�l L Ehman
who is personals known Y-- or has produced a
STAMP
4RA ST '"!N/
ssloFY
MCA CH2T 44
o f11fi 105tf7
09� .di eon Qom;
,'y��/! STATE`���
ffIFlHlI
ss identlflcallon.
STAMPSiga�alryur�e of�Notary—P�^hlif
Print [dame of notary Public
VST' Notary Public State of WFlorfda
Laura Townsend
ores MNCommiss
H 17543S1on
o Exp. W1312025