HomeMy WebLinkAboutchange of sub-plumbingC�7unTY
f L 0 R I D A
PLA=NNfNG & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
NLfASE S[:[ CC T C)N_ L
CHANGE OF CONTRACTOR — ('hange of Contractor is to be signed ant! notarieti b the
and the new contractor o1"record for the cuI•rent }permit. A new permit aphlicatioli must also be complete(I w Itii nc�►
property owner.
contractor information and signatare. A new Notice.. of C'onirnencement must be tiled in the new contractor's name
fbr job Values greater than $2,500 (S7,50U if A: t' Change -out). A recorded copy
C011hl]c'pClnc any work. i'ht re is a $50.00 fee for the Change of C'otltr. Actor. �} must be submitted prior to
x ['JJAN(',E OF SUBCUN7'RAC101A —Subcontractor changes , -
The new subcontractor must till put a Sirbconiractor A�, •� are to be comPlete(1 by the Aener,i� contractor.
Contractor. li emcnt Form. There is a $Sp•00 fee for the Change of Sttb-
-CA11'CEJ,l.A'!'lOi\' OF I'Js'Jt.tbll7" -- ! he cane
ellarlon of :t pertiilt is acceptable only il no w-urk hc., !�r�•n done
canoel atioll of perlpet is t. he stgncc! sued it,�tarized by both the owner and qualifier tit' record. There is no fee For
canccllatinti of tftc permit.
Date.;
—_ — Permit Number:
Site Address: —� —
Uri ,�G-Tr� _ . ilatc. License rL Qp
{-��inal (,(., subcontractor of o,%:nel 'futilde, — "13_ fj(,l.icellse
" ��L�y s= _$trite l.,iccnse ��New fr[', suhcoliu,actor ._SEC' i.lccn,e ��
Reason !ur C:lizcllation
- - ••�•• Gum and al: c and hold harndess St Lucie County, its otlicers, agents and employces from all
costs, feet tt dnnkr cr eristn i (rent any iol arid al: cloiI t"s of u;'tiun for any reason• u'hlch nta}' arise as a r+'su[t of this ctiangr ([[
ti�nitaCWCrSIt17CUFlr[JL'[(11' tti Ciilil'Cllahun ofperinit A permit crlrinot ire cancel ed if Work has been performed.
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SM,AI URE GEIIN, —
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$talc of Ft„riitd• ( 04111t)ut SL Lucie i.,autay 1— 1
The loNowirrL, stcgarrcnt a 7c ajvi.r.;l �t,crl hai,rd![zc 11ri:
or wl
is Pfodu (I
w-13.1�i nfl�„I,�r ft �ynttaliy 1<riusv7y [o me.
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Sign�tit e of Notary
Date
L
te of FLorWa
re
Eir
HH o r709924
('aunt} ON. Lrtr is County
Ihi! itngvt:it; {'I,(�,�rtr,-nl ,:a; a� krnw;:dgrd brt,�re me thl.•
rdp7 nj
far.
-- - Ste. _..vh;� i. persa�lyl,imHn tr.
J��x
`d U�__
ID.
sIgnAture of Not.ry [)ALTO
\iV
'W Notary Public State of Flonda
4; Hannah E Moore
pY My C,:.nm SSion HH 01709,,
Exp res 07-01Q024
PERMIT N ! 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 -'Individual Name)
the Electrical _ Sub -contractor for Adams Homes of Northwest Florida, INC
(Type of Trade:) (Primary Contractor)
For the project located ati�1�l-r�r,
(Project Street Address or Property Tax Ili ll)
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 Change of Sub -contractor notice.
•CONTRACTOR SIGNATURE(Qualifier]
W Bryan Adams
PRINT NAME -"
29179
COUNTY CERTIFIC ATION NONNIER +
Stale of Florida, Count% of St Lucie
The foregoing Instrument nas signed before me This
b, W Bryan Adams
who is personally known or has produced ■
as idriairtcatian.
of NM 4
Revised 11 16-2016
St B.COVTRACrOR SIGNATURE (Quaurter)
Timothy L Ehman
PRI%T NAME
31748 _
COVNTY CERTIFICATION N(,,IBER
Stale of Florida- County of ST LUCIE
day of The foregoing instrument was signed before me Ibis f elan of
,20" by Timothy L Ehman `
Who is personalh known Y__ or has produced ■
STAIIP
S;,RA S 744
r.�
x o tIFW Td6177
dare
%�••s,o°dad the ,�`'.•O��
BOki4��AN
YZI.�iL STATE
as Ideatl""a ion
SienalureorNour�pbnc
Print Name of Notary Public
°,fa*' Notary Pubilc State at Florida
+ ]aura Townsend
My Commission
NH 176435
Y
Exp.911312025
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