HomeMy WebLinkAboutCHANGE OF A/CST. LL1C1
COUNTY
F 1. O k i D r,
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 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 Chan
commencing any work There is a $50.00 fee for the Change of Contractor�� y m' be submitted prior to
X CHANGE OF SUBCONTRACTOR - Subcontractor changes are to be completed by the general contractor.
The new subcontractor roust &tI 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
Permit Number:
Site Address:i. 3f., 1 .*. / I !
` e f State Licensee 1dyg9 SLC License
Original GC, subcontrac r or owner/builder,
State Licena I - SLC LiE
New GC, subcontractor License. {y f I
Reason far Cancellation Contract Disputes
The undersigned does hereby agree to indemnify and hold hamdess St Lucie Coup its ofilce , —
costs, fees or dareages arising from any and all clam of action for any resaon, whiten stay arise as s result aaf this change m all
Me�tbcontractor or cancellation of peewit. A permit can a cancelled if work bi been performed.
.—SKNAMM of owr(or own«Auitdecj
nip o>rNeli,u, eo " tt for new c3C,
appitcabte)
PR I [a r NAt+IE W. Bryan Adorns PRINTNAME
_ [ F
Slate of Floeids, Coamty of St Lucie County
Ths following iostrvmau wat eclmowle%ed before me Bois
day Of; 1 .—, 2044 . by j
c
ar PfNotmlry
;�
•av•'• ,'',��i
Revis,=d (-4 - - 1 ) 6
State of Fbnda, Coamty of St Lucas Com ly
t°uDWift iaatraimmt was KbMVledged before me dais
f ' day of
. . —'*tOknown to
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PERMIT #
COUNTY`
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB -CONTRACTOR AGREEMENT
(Company Na1ne/1DMV1du81 Name) —J have agreed to be
the FiVAC
Sub -contractor for Adams Homes of Northwest, FL Inc.
(TYpe of Trade)
(Primary Contractor)
For the project located at
(Project Street Address or Property
L
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.
� t
OR=IGNARUR�E(iju-sFm—er)
W. Bryan Adams
PRINT NAME
29179
COUNTY C$RT—M—CATION NUMBXR
State of Florida, Conaty of `Sty Lucie
The foreplas Instrument was Signed before we this l f ] day of
MArd— `
so,Zb,
who �
penoaall kao+ra �r has Produced a
as idmMileffidom
store aCOWWV Pa6+jllo STAMP
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Revised II-1001r,
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STATE
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S(iB,CONTRACroR SI URE ( aaitfler)
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COUNTY CERTWICATION NUMrR
State of Florida, Calmly of .�
The foreFolay instrument was sbgned before we this JjD day of
who is tangy lmattIf�a� ✓ Qr has prodaced a
u lCmd1ka002_ - —�
ITe of 'txry Public STAMP
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lame of Notary PH We
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