HomeMy WebLinkAbout22022415_25_04PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34"2
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
IJ�.�:�Y�� e . e ll. a t► .
CHANGE OF CONTRACTOR —Change of Contractor is to be signed and notarized by the properly owner,
and the new contractor of record for the current permit. A new permit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
for job values greater 'than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There is a $50.00 fee for the Change of Contractor.
X CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: Z 2 mil% 2 Z
Permit Number: l � • U ! D
Site Address: _ .
NC Unlirnfled _ State License SLC License 29727
Original GC, subcontractor or owner/builder
Del Air Heating and NC ---State License_Lh�IC�y9h1,ASLC License
New GC, subcontractor
Reason for Cancellation C y L r r t it le_ P4wv }rs
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
___�DntracWrf b,_S9nlractor or cancellation of permit. A permit cannot be c celled if work has beeripsirformed.
' SKTt1REOFOWNER(arosmerllwildery 5{ONATURFCp,&
tALCo1AC7)R(unewGC,asapplicable)
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PRINT NAMEL4, om_PRINTNA
4� r.�eLyti
state of Flonda, Countyof St Lucie County
The following msuument wks acknowledged before me this
_dayof ,10fit AA J-h-bYtt=.��ct�4.�
{ _ .. 40 Is penonall) known to Ine
or has rod aslD.
si ature or tart' Date \tl«ttttltllf!!//
Revised 04/l5/16
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•'.r�Ao^ded tS+� te` r
ylllc Uada�'r e• aQ0AN
/18Z1P STATECQ "�`,`
state of Florida, County of St Lucie County
T}e following mslrumenl %is acknowledged before me this
-day of, 2.a e720,by_�4 , 5 Z,;_.
tvlw is.[, rsoral li, knouT. to
me o alto has produced as ID
Signature of Not Date
MICHIELLF SODOM
Notary Public
State of Florida
Comm# HH10476
Expires I/26/=
PERMIT #
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
DEL -AIR HEATING, A/C & REF. have agreed to be
(Company Name/Individual Name)
the MECHANICAL Sub -contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) (Primary Contractor)
For the project located at i l�
(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.
RACTOR SIGNATURE (Quali(ter)
W Bryan Adams
PRI\T NAME
29179
tdt)ATY CERTIFfCAT10N NI:%i 3£R
Stile of ilorids, County or .St Lucie
The foregoing instrument was signed before the this .4. do% of
.&ItI_. 20j' ) W. Bryan Adams
w ho is rrsoRallr know p `E or has produced a___.
as d liritalio
naturr of 'Notar}' Public
rrtttuttt�
Sl'B-I:O\T CTORSIG,NAT (Qualifier)
PRINT NAME
27191
COI'\Tl CERTIFICATION NUMBER
Slott of 1.1orida, Counh or ST LUCIE
1'Ye forreoing iaslroemeal was signed before me this `� do) or
whd'ls�rsonRll3known k or has produced o
of k1lp11r4eRflRn.
STA 11 P STAMP�'�,a
Si Rafnrr o r ry pub k
r n1 Name or Notary Public `���rr y
Revmd 11 16 2016
Print Name of Notary Public
MICHELI E SODpgp
Notary Public
State of Florida
CDMMN HH183476
Wires 1/26/2026