HomeMy WebLinkAboutchange of contractor electricCOUNTY
F L D R I D A-•
F
PLANNING & DEVELOPMENT SERVICE S
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FOR I' PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLEAS1. SI:LrM Cl L• (}i-, I'1{
� CRANGE OF C,OI�iTRACTOR - Change
and cite nctir contr�c•lor W-rccotd for the r,c of Ca1t[ractor is I() be signed and norarized by the Property contractor informaliapn and signttture. A ne�►�tNotice 11orf Cbn>tnencenlr;nt rnttu be filed in the new Contractor'sleteowner.
pceme atrnwv tinrl must also be cortttciname
for job talues greater chart $2,StlU [S7.500 if Ai(' Changz-out}- A recorded co
cottutt' acing any work. Therc Is a S50.00 fee for the Change orC:ontractur• natttc
p}� must be submitted prior to
-CHANGE OF SUBCONTRACTOR -- Subcontractorcharlge` are to be cnm�tfoteci hti' r}te �rertc
Co new s(lbcontractor nur;t tip! ou! a Subconirartor A�,ree nlent Form. There is a S50.00 fee for the Chanp
Contractor, ral {ontractot.
�e of Sub-
- mlon o EI.L��7'lOi�° U1 1'f:[(,�ll�' _ T'he canrc Ifarrolt of i; ltertttr( is acc4.ptable only it nn k, ark has beell n dnnc
('Zrtccllati�in c1F pernut I; Ip be �rgncll ;and nt�tanzed I YI r1orl tile o�rn 11 trtd epta Qualifier of record. There '
cancellation of the pet•tnit.
is no fee For
Date:
Permit lumber: 716 41
Site Address: - -
Urtt;inttl (i('; sa U o ttricl K lycr 111icr State License �L13(� y'
hcty CJC, suhcclnuactttr. ''�Statc !-,iccnse�._
Re. son lur C'anrcllariora _ 1Y- r
� he undrr5i�ncd rT,�,r•, t,,r...t... _
;'-� "' e,rrr,^nlmry and hold harmle5,s $[ Lucle C'otrttty, i( a1liccrs, a -
c'.ay l`, fors or danr� rS ari;int trorrr Any -mid sail clairlp� crf 1lCth n for any reason, whrch nrat• 1tlik as a rcsuit of Ihi. chan a• ,,
ScnLs and cmpf,py c� Frnrn �zl!
of
cc�slrarr�,rutbcunlracror ur canrrrlalton to t>e.nntr .► permit ctuartot Ipr cancct rd if pork has been perfornted.
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SII.rJ.1]LfRE GEVk CC1N rk,tc'r1)RaPl'ri�ab ci
"euct. of I'lowla ConrnnF SI LrlCie t_'4utin �� "-
fliIc p=clt;;rr'c'sr wn.,ra pile zw�
W. 3�,4,!i•> is per.onallS krtU�7xry rrK•
Slgr, Irtrc nr iYnrun- �'�� -"
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• Nr,e'
r° I r � 11Puoarc Stale W FV,.da
Hannah E Moore
a ti�My Comm pn HH 017pgr;
E>rwres 07:01r2024
Sr.lr; of E iar�ra t ,ur:ty oPSr. Lsn.ir-Caa:rry
nc� f0il_'WI:rg,n.trunrew was 9ck.,nvL
! clayna . �dgcd b:l ,re nc!h
. �- r .tiSt1 �,wle�. rc ryr'rsrri�lf}ku�/v.�r t,.
0la> prcrQ
awXeSgwturcurNwary IT).
�Tvo�
ro �� Noary r'ubr,c Stale of Fapr da
Hannah E Moore
A �P My .: Iiif11S$IQn HH 01_09:
"7oi F% E ap'res 07:01r2024
PERMIT# I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
Ehman Electrical Contractor, LLC
(Company Names Individual Name)
the _ Electrical
(Type of Trade)
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
have agreed to be
Sub -contractor for Adams Homes of Northwest Florida, INC
(Primary Contractor)
For the project located at _j -,
(Project Street Address or Property Tax ID l
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.
CO,NTR ACTOR SIGNAV RE iQualiriert
W Bryan Adams
PRINT NAME _W
29179
COI'NTI- CERTtFICAT101\ NI 1lBER
State of Florida, County of St Lucle
The foregoing instrument %,as signed before me this . day of
20 b) W. Bryan Adams who is personally known Y, or has produced a
as idpoliGcslion a
or
Revised II-16.2016
STAMP
• • �},1A15tlpq ••.`F�
{ri GH z? $66%
*.•� a�4•LN:
7'. c �fiF1106177
_7��z�
St B•CONTRACfOR SIGNATURE (Qualifiers
Timothy L Ehman
PRI\T NA%IE
_ 31748 __
CO[',NT1' CERTIFICATION n[ ;\IBEfi—
State or Florida, Countyof ST L.UCIE
The foregoing instrument was signed before me this dar of
Timoth L Ehman _
who is personally known 4XI—or has produced a -_
as Idrnlifica ion.
STAMP
Signelure of Nofarr P hlit
Priol Name of Notary Public
�,•=ownsend
e of Florida
nd°i~