HomeMy WebLinkAboutCHANGE OF A/C CONTST. L L c--71
COUNTY
r i o R 1 n_
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300'VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR - Change of Contractor is to be signed
and the new contractor of record for the current permit. A new and notarized by the property Owner,
mpleted with new
contractor information and signature. A new Notice of Commencementmustbe filed in the new ust also be ocontractor's name
for job values greater than S2,500 ($7,500 if A/C Ch
commencing any work. There is a $50.00 fee for the Change ofCo tractor.
riled copy must be submitted prior to
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 PERAUT - 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: _-�) t A 2 Z_ _ Permit Number: I Q
Site Address:
b?S L3
Icli rr � State License f _.- — _
Original GC, su - ontra{c/to or owner/builder SLC License
New GC, subcontractor State � t ``- SLC Licenses �f
Reason for Cancellation Contract Disputes
The undersigned does hereby agree to indemnify sail hold hariNess St Lucie Coun its ofii ,—
costs, fees or damages arising from any and all claims of action for an reason which ma arise saga result d thischange
from all
bcontractor or cancellation of Permit. A y y hange of
p permit a;;AZ
ncelled ifwork his l�eea perlarmed.
..—� J ',
OFdWNER (or awnaibttilder) ` -- )EiVBRAt.COysj�
R (or nary GC, as applicable)
PRINT NAME W.13"nAdams pR11VTNAtr1E
Slav of Florida, CoNty of St. Lucia Coumy
The foHowtag inswmreat was Whowledged berme me thus
or has
`� Itt11NIJJ/////�i
f lYatary
Revis,id oa - r.! : a
state of Flatda, comfy of St, Lucre county
The following utacwamt was acbrowledgel before ma thn
1- _ . _ who K known to
me has
-- i as
�tareof otary
N A STA�FY 10111
Date �� . , • _;1C�Ar �i
a H 2)�'.
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AM 106177
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PERMIT #
Sr. Luc# 7 7-
:COUNTY "
r� o u i u
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
(COmPAnY Namell"vidual Name) have agreed to be
the HVAC
Sub -contractor for Adams Homes of Northwest, FL Inc.
(Type of Trade)
(Prlmaty Contractor)
For the project located at
(Praject Sweet Address or Property 'ax 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.
OR SIGNATURI; (QnaWier)
W. Bryan Adams
PRIN NAME
29179
Cot1NTY fON NUMBER
State of Florida, County of `St Lucie
The foregoiog lostrument w= signed before me tM _JL,3 day of
2011, by
3
who Is personatty known V or has pmdnced a
as ldmliflesNnn /i
Revised 11:IWO16
STAMP
trH 2? 4W-
Z z t941106177 #
`
I L ONTRACt ORS RE ( ustltier)
PRIINT NAME i i '
COUNTY CER7'Q+tCATfON NUM$ER
State of Florida, County ofy
The foregoing instrucacal was sigoed befere me this . i " day or
11• r5 i 291�rby -- ,
r�
+rho is senatl ka n has odneod a
.p _. pr
}-n
m of Public STAMP
111111rrr
lathe of Notary Pobec IWO
z
sYFlFI 106177
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