HomeMy WebLinkAboutchange of contractor+,
COUNTY
F L 0. R t D _. .
PLANNING & DEVELOPlN7EN7' SrRVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
S
��A�LATIO
NLLASt-,Sf:Lf (7 ILL
C.
_CHANGE OF CONTRACTOR — Change of Contractor is to be sigrlcd and notari2e[I b rllc
and [he nc►% eontraelt)r o1 recor(J For the current permi[, A new permit ahl)lication rtlttst also be co 1
con[rtictor information and signature. A new Notice. of Cr)mrnencenlcnt rrltrtit be filed in the new Con CraCtow. Owner.
for job alucs �* F 1pletccl wrth im
J ,realer than $?,5{}0 (57.500 if A;(' C'hrrllge-out), A recorded c(1 me,st be submitted
cotllllle"C1119 ;In)- worn. There is a $50.00 fee for the Chinge of C'ontrar cor $ rlr to
p}� prior to
x C1fiANGE OIr SUBCONTRAC 1-011 Subcontractor chanties are to Lae con] lc ted }}}' the +r
The new sttbc(]nt[�ctr�r nntst fill out a Subcontractor Agreenlcnt F'orrn There is a S50.00 fee F'or the Chan
Contractor. P ' ,eneral contrr,ctol,
Change of Sub_
_ t'+�l\'CF.I.L.17-IO,V O1• prv[2_YI1l - i-I1[.• r'NnCcllaffr111 Of llrr[ltit [s acccptabfc only it no +t'ark has brcr, done.
C arliCli:ittt)n �3f f)ernlit i. la be signc%i and "Wirized by both he o�tincr atrtf qualifier t,f record. '"
cancellation of the permit.
tThere is no fee for
Date: 2 t Z
Permit httatber:
Site Address:
(lrf) fiAll.,(' silbc4FuraClor or intiner+7,llillFcr --- _ St,lte Licenserig
Nely G(', trizcc,rlu;lct,)tC -���� �-�'`- State 1 iecnc�,.�i 04
��SL(' i.lccnse
Reason tur Can.cllatlon �b��r���
l'he undCr5iyI1CC(i doe. I,.• F, �� �4 �ls. —ry
-- 'c rn Ina,lltnrry antl hold harntleSS S[ LuCic COuilty, its oflircrs, at;cn[s and cmployrc s frnrt1,111
c08tti, fees or drk,Tuglcs kw4ing !torn tiny and nit cl.1it11, (Iructhin t'i?r any r,ayt,n 1L'IEitifk irF t�' illy as ;, rc,ul[ ut'thia clt;tn r trl'
Ci+rltrdC[Jr�Sllt](;(Wrin t[Or or Ci111CCttrllrJrl (,; lk�rmir A perrrli[ CunrrOt t)c c:Inccl ed if work, tlas been performed.
5 i
SIGNArURl
.E•1)uiltlt-I'1 SII..N:11 t1kE CrE�t: - ' 7 i:it rl;,t, CDC TN,�'I'rt)R r r n"w (;S . as &pitlitr+b cI
�[trlc Gr 11i,iiitd- [ GtIRL)' tl(jl L C10 cvmlju.1
The ?� Ilo�autg rS,;pv1: c•tt ,.;,,.ter k „„Ic!>al I cri•r, r1,r thi:
il,ly ,
u fa
Sfkrk rtlrc nr i+;orurr [hrr --.. -. .
E:Etp
upl,c Stare of For da E Moorem g,%on HH a I,1+01ROZ4
NIAt; t'f
r)+c rollos.•rrr; ylarrum:rl ue:1.:.,,ui d�cd b:larrr nr the,
'.- .dryr,t Y 2+,doh
51i � _:,h�. ka rkrxr,rpfry ln.ix7s to
r : wt?rk
SignmureOrN tar, t> .�....,.
`.111 parr N, ary r'urll,c Starr d Fronde
Hannah E Moore
My CO-n =xSson HH 017095
~?a ExpE.p�res07.01r2024
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 Namellndividual Name)
the Electrical Sub -contractor for Adams Homes of Northwest Florida, INC
(Type ofTradc) T (Primary Contractor)
For the project located at-- _ q 3
(Project Street Address or Property 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
filing of a Change of Sub -contractor notice.
CONTRACTOR SIGNATI RE (6alifierl SCB.COVTRACTOR 51GNATURE (Qo�lifirrj
W Bryan Adams Timothy L Ehman
PRINT KAME PRI\T iiA%IE
29179 _ 31748__
COC\T1 CERTIFICATIOn �C�IBER COUNTY CERTIFlCATIO,Y N;dIBER '�
Slate of Florida, Count). of St Lucie ST LUCIE
S to to or Florida, Ciri►ilty ►f
The fortgoing instrument n as sigard before me this 1 day of The foregoing instrument was signed before me Ibis 41AY of
.2077,b1 W. Bryan Adams 2qLby.Timothy L Ehman
who is personally known or has pro-duced a who is personalh known X or has produced a
as id liricalioo
STAMP
a *r u tic a�'40"LrySTAMPSignalar
IN meoaf 1ti ry Public ��1►1H1tItFl�ff
Print Name of Nolory Public
SW S r4ze ��
:oos"'4001i� Notary Public State of Florida
Laura Townsend
Revised 11 16 201G +�My Commission
S O , o +14iFi 106177 ii��M1 HH 175435
•,CA d a. S' Exp.911312025
i IPA�'yAonerd thi t\%z �r `Z
C unit
,/''8��`\\\/,'/r'11IIfIII1