HomeMy WebLinkAboutchange of sub contractor (2) E�
PLANNING & DEVELOPMENT SERVICESt �uTti�
WI —
BUILDING & ZONING DIVISION
N 2300 VI AVE APR 0 12022
FORT PIERCE, FL34982
(772) 462-1553 FAX 462-1578 Lucie County, i?vrmittingc-- _
CHANGE OF CONTRALTO SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF TIE FOLLOWIkL
CHANGE OF CONTRACTOR-Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the cu
rrent permit. A new permit application must also be completed with new
contractor information and signature. A ne. &t w Notice of
Commencement must be filed in the new for contractor's job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted rprior to
commencing any work There is a$50.00 fee for the Change of Contractor.
X
CH
ANGE 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: /�7 6 ZZ Per -
Q mils Number: Z l07 66t6 f
Site Address:
State License_0Y1Z9L 777 SLC License Original GC,subcontract r owner/buil er - --
i II (�' h�zrtiY`K;1 L1_� State License%E< f�SLCLicense New GC,subcontractor - -- ---- --- -
Reason for Cancellation Contract Disputes z
undersignedThe
hereby agree to indemnity and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of I
- ctorrs bcontractor or cancellation of permit.A permit Cann cancelled if work a een performed. I
�TNA
- '" r
OF OWNER(or owner 6_1dder)
>;ICi¢ATURE GENERAL,CO CTOR(or new GC,as applicable)
PRINT NAME W.Bryan Adams r. t l /i h1 i �fl
TRAIT NAME���z,�✓'
- j
State of Florida,County of St Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this
� 'I�e fy9Mowing ins ent was acknowledged before me this
day oft ,20 7i�yYL!'t fi �"'aaY of rG�,20ZLby � g
� ��S who is personally known to me � [r-���-
who is personally(mown to i
or o has p as ID, me has 3
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ISnatur (Notary `� �H27�CZ. /'� Slgastureof otary Date � ,•o tass+av •,• ��i
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Revised 04/15/16
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PERMIT#
ISSUE DATE
ANNE
PLANNING &DEVELOPMENT SERVICES
® Building& Code Compliance Division
BUILDING PERMIT EAR O i 22
SUB-CONTRACTOR AGREEMENT
County, ParinittinJ
-B i I h
(Company Name/Individual Name) a have agreed to be
the HVAC
(Type of Trade) Sub-contractor for Adams Homes of Northwest, FL Inc.
(Primary Contractor)
For the project located at <D7i-7 ,1�; C�f -I- f-'%�
Vroject street Address or Property Tax I #) t
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.
i
CONrR�C!'OR SIGNATURE(QualiIIer) cS 1� / ��/�{ �£•�-----'
/[TB-CONTRACTOR S[GATTIJ1tL(Quenner)
W. Br
yan Adams
PRINT NAME
29179 _
COUNTY CERTIFICATION NUMBER
COUNTY CERTIFICATION NUMBER t
state of Florida,County of St Lucie
-�'� State of Florida,County of ST Luc
The forA;;�E
i ment was signed before me this36 day of (` i
Y The foregoing instrumeat was signed before me this_30
say of
20�t by
Ibr -soy-) i
wha Is personally known Y or has produced a
wb0 i9 personally(mown;or has produced a
as id cation.
as 1 e dlicatioa.
STAMP
S[ nture of ijotary Public \\\\1 // Si lure of otary Public STAMP {� Illlllulll
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�Cl Fyfr0. \`������S�A•STALey// i i Print Name of Notary Public •• SH 0No• �� .• • \SSIt)ly
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