HomeMy WebLinkAboutCHANGE OF A/CPLANNING & DEVELOPMENT SERVICES
COUNTY
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CPica CONTR&CLOANTRA T ANC LL TI PE
MM
THE FgjLj
GRANGE 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 $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 PERNHT 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: 3 10 ( ZZ Permit Number; O - —
Site Address:
_ -J
+ State Lice
Origina�GC, ubcontrac or owne4ilder SLC License
. ,-- k #i t` State Li iLicense(� cep i •G I New GC, subcontractor SLC
Reason for Cancellation Contract Disputes
The undersigned does herebY agree to indemnify and hold harniless St Lucie County,its officers costs, fees or damages arising from any and all claims of action for any reason, which ma arise as as result d Joyeea iron
bcontractor or cancellation of permit. A wthis ay of
� P permit Gao;A!:��2rEi
cancelled If has been performed.
OF OWNER (or ownedbuilder) new (iC, u epplMeblr)
PRINT NAME w•frryanAdams ^' //33 °
hRWT NAME _,
state or Florida, County of st. Lucia county
The foilow"S m tnsu = was aclosowledgad before me this
iL� dayofl k 20 by xilzr,,
`—�°�:s�taa9n� souse
Or
[Notary
Revised 04f.5fI6
State ofplonda, County of SR. Lneie County
TU following k0umrrit was ada� beta. ma this
—ib--4ayof4hlr�.2OL4by •t— T
.l -Who is Jnnqq#y imown to
me has ._asID.
of
Date ��� ,.•;1SSi0N� i11,
� it
NFgi106177
O;A °ig Bo N
wed sn .
STATE �����
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUQ.DING PERMIT
SUB -CONTRACTOR AGREEMENT
i i "+.. 4;
(Company Name/In ividual Name) i �- have agreed to be
the HVAC
Sub -contractor for Adams Homes of Northwest, FL Inc.
(Type of Trade)
(Primary Contractor)
For the project located at
(Project Street Address or Property Tax ID 1!)
L 1'1L
.k 3
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.
ORSIGNATURE (QeullIIer)
W. Bryan Adams
PRINT NAMI;
29179
COUNTY CERTIPICATION NUMBER
stale of Florida, County of `S_ Lucie
The foreving instrument was lizeed before an this I b day of
ah�grso known Ze, has p odaoed a
a$ UdnAkSmeinn. n
Revised i l 1wo16
STAMP
H'2
�N
Z -It AM 106177 : #
o�o°°ved th y' x
te! , STATE --.0
}
SUB�CQNTIR CTOR Si URB (Qya 6
�Rin�T N i
3� {
coIIN 1 Y CER7 !j►lCA4 -1 IY1WffM&K
State of Florida, County of e
The foreg°htS lastrumcut was signed before me this IL day of
0fL4-��- _, 2Wd, bby r 1
wbo_Ntso ✓ °p has prodaeed a
as lddtllkatlen- � _ _ � •._
Pre of Pub lEc STAMP
1{{III!!"
laws of No � � y
Lary PaWe H 22
y AM 106177
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