HomeMy WebLinkAboutchange of contractorPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBC NTRACTOR OR CANCELLATION OF PERMT
CHANGE OF CONTRACTOR Change of Contractor is to be signed and notarized by the property 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 S50.00 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: 212 1 2-2 Permit Number: 1 l + _ I ?
Site Address:
A/C Unlimited _ State License SLC License 29727
Original GC, subcontractor or owner/builder
Del Air Heating and Alt; State License 12r-1Ahn1SLC License
New GC, subcontractor
Reason for Cancellation Cei
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fron
costs, fees or damages arising from any and all claims oraction for any reason, which may arise as a result of this change of
f__0n1racrM'n1taCyn1rdctor or cancellation of permit. A permit cannot be c celled if work has been garformed.
' 47007uRIOFOWNER(orowvnerlbuiIder) SlaNATORFrt;44-
Sittle
The rollowing instrument aas acknowledged before me this
'Illy day or,�,r. �1. 20 L J. by-b . t�i ti
Mho is persoml!y known to me
or w%,as rod a as tD.
S store or isry Date \tt11111N111111j�
Revised 04/15/16
\\S TA
1dS311op,c
•� C,HV �Oi'•
Ob
+Hilt 106177
�'� 'yA°dad �� �•` ' 8 .�
'//GC STAISC. 'k
Slate orFlorrda. county orst Lucie Couniy
e fo ;owing instrument aas acknowledged before me this
day Of 20_L[may
who is rsomtl% known to
mt o xho has produced as 1D
Signature of hot Date
Notary Public
/S/�•t��atte��o�,ff{ lF!wlloeerr*ippd�.a���xx
W • w.�i1 � 11111► r H10476
Expires 1/2GM26
I®
PERMIT# I I ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
DEL -AIR HEATING, AIC & REF.
(Company NameAndividual Name)
the MECHANICAL
(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 _—I f :{, / i
(Project Street Address or Property Tax ID k)
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
Fling of a Change of Sub -contractor notice.
'TRACTOR SICNArI'1tE (Qualifier)
W Bryan Adams
PRINTPRINT NAME
29179
COUNTY CERTIFICATION NIIM1 ER
state or Florida, County of St Lucie
The foregoing instrameat ts-as signed before me Ibis _ .lay of
>�« n�.2o2-1.b} W. Bryan Adarriti
who Is ersoaaily imewil 'L or has produced a "
as d liftcatie
STAMP
nature of Volar}' Public " ..._
```���1�1�1ttplllff�<<��/'/
r al Na"meeoof.Nolary Public ��`JT" ::Sr, Fj•
Revised 11 16 2016
`` ••• 52) O •• '�
*• a►a� �*
Z c ON106177
e� •t.
09 •��'j',o°�dfd thN �
°btie unAa•• \�*
i
/'C' /C, STATE
`St'B�"CO�\'T�-CTOR SIG\AT fQualifer}
PRINT NAME
27191
COP\"( _: CERTIFICATION N UM BER
Stair orflorlda, Counu of ST LUCIE
The foregoing ins#rumen was signed before me This 21 day of
��. 2022.by
wk is Personalb known I- or has produced ■
IS Identification.
STA i11P
Si aalnrr o 6 r} Flab is
Prins Name of Nolary Public
MICHELLE S000MC
Notary Public
State of Florida
• COMM# HH183476
fxplI W A14Cl2o26