HomeMy WebLinkAboutchange of contractor electrickS,T1uUC-1f-
COUNTY
f L o k I L) ri
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLEASE 3ZLfg1L= F
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
and the now 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 Warne
for job values greater than $2,SOti ($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 Forst. 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: 1CL2LPermit Number: • ��
Site Address: -
z4a ;I
Original GC, subcontrac or owner/builder State Liccnse� 1lfJA_SLC License c? 1
. � State Lice I # i<*. c' '•' G
New GC, subcontractor SLC License �%I
Reason for Cancellation Contract Disputes
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees
ti--
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this c}>ange of a!1
bcontractor or cancellation of permit. A permit e;�AT&
cancelled If work lei I�eea performed.
OF 0 NER (or 01ma/bttilde6� as aPPable)
OENBRA[. - .-
li (ornew EIC,
PRINT NAME W. Bryan Adams PRINTNAAM_J '—'LCC!1 �,
#�}il
Shte of Florida, County of St. Lucid County
The fou*wms mat mmew was atlmlow U%W before me this
t 4y0I f hidf ., } L'�, L I LrT
blown tome
or has -- - -
-as
ED Illltttll+N�/
(Notary � •••,,�' ////i
Revis;ad 64 '' -� 1 16
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State of Floods, County of St. Lucre Coaaty
The foUow"inmmwt was aclmowledged before w this
€ �_� `whoa s�raopN� knogm to
_es In
\N'AN, 1tt1S
*h" of story Date �� t
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PERMIT #
T. _:L..0 t -I F_.z
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the_ HVAC
(Type of Trade)
For the project located at
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
Name)
BUILDINC, PERMIT
SUB-COMACTQR AGREEMENT
have agreed to be
Sub -contractor for Adams Homes of Northwest, FL Inc.
(Primary Contractor)
-
?RMicct Street Add is or Property Tax [D
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,
CtRT�OR SICNATMM (Qualljltr) W. Bryan Adams
PRINT NAME
29179
COUNTY C$RTIPICATION NiiMBER
State of Florida, County of St Lucie
The forW'ng iastrumeat was signed before me this S C, dgy of
1 lr E 20�zi by
who 1s persosauy known i! or bus produced a
as OIL
stun of ry Pobue STAMP
,i i0,0\,Al y
Revised 11 1612016
sIm NaTIIACI OR s URE
(Qnallfler)
PRINT NAME
"Jurff T CERTHgCA fON NUINBER
State of Fladde, County of p
The foregoing iwtrumeut was signed before me this day of
1, ze.) i— by
/ .ram
whn— //j� 4seaa>;y ��mp ✓or has produced a
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s s T t Natte of f
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