HomeMy WebLinkAboutchange of contractor (2)Cou NTY
r L O R t 1J A-'
PLANNING & DEVELOPLMEN7• SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT' PIERCE, FL 34982
(772) 462-1553 FAX 462-1,578
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� CHANGE OF (:OIYTRACTOR - ('hanger of corltt;tetor rs to be Signed and notariie(! b the 'Ind the new ct)ntI etor uf'rerurd for tite Cltr-retlt pool:[. A I,eu
contractor informitiun and signature. A new Notice of ("omntenel.""t ' must be filed In the new contractor', ,vloperty t3Wn21',
perntir at,pGcatiott must also be enmf,lete(I wrtlt ,tcu
for job �:tlues greater than $2,St10 {57,5pQ if q.0 C}tttrtgz_otrt}. �► recorded Copy name
�, any work. 7 here is a $50.00 fee for the f �,ange of C'nntractor, py tnu't be submitted prior• to
x _C111ANCE O1 SUBCONI RACTOR -- Subcontractor changer are to ItE t orn�t�ttr (1 by t►Me ten
The nexv subcontractor mtist till out a Subcontractor A�•r�crnciEt Form- There is a $SQ,QQ fee for the Change Contractor, � c�rrrl tonrr�rctor.
�e of Sub-
.cArcE1.t1;% rlo�T 01: I'I,,12�Mjl. _ 'I -Ile cxnceJ��rr�n of;, lrcnttft is :t.4c.ptablc only if no work- It.lti been cI(trtc.
C'anceiiah(�n of Peintit rs to be N1911cd and lux.in7ed by t!t,th the a>rnct ,,ta qualifier 01 record- There is be fee for
Date: _
�-� Permit Number: I aL _U91
Site .Atlrlress: 5'L���v L
Original (.i(.', subcontractor of uun�l i,rril{lcr _ St;ttr License t
IVC111. UC, Subcolitlactui Ctrgh-119�_Statc. i..icrnse �� }75LC' L.iccn.e3(749
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7 he und�rciun�•r( .t.,... I.._.t. —� -- - `��
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cots (eC� (11'(tF117klQC err5lnnIfiorll any;tAr,llZlrC111,1l�1%(Ira(-ricrotl'et auvLr351[C�attcfL n[tyllrlicm, ;I Ills It (,t fhis ()ye,chdi'
+ a�ttr [cw! r.ubc untl ,L rate ur c:mcel. iron of i,entc and empEayees Front dal
— - { rntn ,1 perm cltnrrot he cancel! ed if work Jtas been performed. gL of
SIC ti'+4 rt l L' frr' U;tf R J. I ,, — — .
o>4r.crbvild�r'1' _
Sltit;.+ll t'r2E Ci(vVE (.'Qt fk,lt-r[]
+�A.%1 fi:.,�;G � it fornti,s(;I-'.a<apl�t:r,Lb•tF
tiy[G 8r t'r.alclu, Cpr]lllj of St tIle. (' L(r1h:11
The =oliowlu ut,ll n'rra ua.a rLI •.; Ic! nl heri o nle Irli.
W� • �IF _ v - ,]'.'v, Is jll5 krr1JmJLQ Ill,
prude d —
�:ts iD
Sign Pure of Doran• Dare
f
i7Lfubrrc Slate of Ftoras
annahE Moore
p' My Commtss,onHr!o,'u9,
'41IaAdExpves 07r01nO2a
ofl:,urla. ('ov, tj nIF Ltivse(C.u.ary
FK fav,,ma a Lr nrrrst aq a, kr^.ttui�i�cd �btt5lre rl ? d,Fyrlf r } h!.
T — - �C� ��t�iti� Ic IxL�f+rptiy i�J47u71 ty.
Slanrtrurcor,'iotary- Italy
=HiannahEc Slag d FlomMooreS<on HH O 1709412024
PERMIT# I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
Ehman Electrical Contractor, LLC have agreed to be
{Company Name!'] nd ividual Name) ---
the _ Electrical _ _ _ _ Sub -contractor for Adams Homes of Northwest Florida, INC
(Type —of Trade) (Primary Contractor)
For the project located at
,TqV,0 Lie
(Project Street Address or Pro- ert�
M
It is understood that, if there is any change of status regarding our participation with the above mentioned
project, the Building and Cade Regulation Division of St, Lucie County will be advised pursuant to the
filing of a Change of Sub -contractor notice.
CONTRACfORSIGNATI RE(Qualiferl
W Bryan Adams
PRI\T NAME
29179
E_6t_ TY CERTIFICAT10N W('_HBER ._ ^'
Slane or Florida, CountY of .St Lude
The foregoing instrument nas signed before me this 2—day of
W.,Bryan Adams '
Who is personally known Y, or has produced a
Revised I I-16-2016
SpRA S r'44l������i
:4i 106177
�i� �' • bit: Unber';Ti
STh 1 rF
St R-CONTRACTOR SIGNATURE (Qualifier)
Timothy L Ehman
PRINT NAME
_ 31748 _
COURTY CERTIFICATiOY U,_101BER
Slate or Florida, CaNnh' of ST LUCIE
The foregoing instrumeni was signed beroreme Ibis, daI of
,2Qz , Timothy L Ehman
who is ptrsanalil known X or has produced a
as idratlfta Inn.
Signalryur�e Le'r N 0-1-z-7
A WbIric
�`R�r�
Prinl Dame of tlotasy Puhlir
;orsr•4o Nalary Public State of Florida
Laura Townsend
MY.H 7542CommisSIon
y �of No Exp. gel312625
STA**IP
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