HomeMy WebLinkAboutCHANGE OF SUB-CONTRACTOR 4-1-22 PLANNING & DEVELOPNmE.NT SERV:IC
Well - BUILDING & ZONIIN'G D.IVIS.10 � 'a �'°�'
• 2300 VIRGINIA AVE �-l. �D22
FORT PIERCE, EL 34982
(772) 462-1.553 FAX 462-1578 FAPR.
�e county, remitting
CHANGE OF COS
- TRACTOR S UBCONTIZACTO
k OR CAiVCELLATION OF PERMT
PLEASE SE;LECJ NE()I-
. I'fiE l=0L1.0W1nfC;;
CHANGE OF CONTRACTOR-Change:of Com-ractor is to be signed and notarized by the property
and the new contractor ofreeord for the current permit:. A nets permit. application rYtust also be
contractor information and si�nlitn"e. A new Notice. of Colttntencentent must be tiled in the new co contractor',,
crrnipleit:il with ncu:
for job values grealer than S2,500 (S7,500 if A/C Chalige-out). A recorded co
commencing ttante
r any work. There:is a S50,00 fee for tfie.Change of Contractor. p�• must be submitted prior to
X CHANGE OF SUBCONTRACTOR --Subcon.trac-cor changes Lwe to be com .Ic
The new Subcontractor mutt till out a Subcontractor Aglreement Form. There is a SS0.00 fee for t
ted by thy.general contractor,
Contractor, he Change of Sub-
PLIZ
cancellation of
is t be signed
IJT- t.he-cancellation of a permit is acceptable only if no ��o,"I: has been done.
Cancellation of permit is to be signed and notariird tiv both the owner and dualifier of record. There is no be
cancellation of the pe►mit.
fee for ,
Date:
Permit Number: ? -0C(R3
Site Address: -Ue,5 Qc%, rc
Original GC,SIIbCOlttr'aCIOr O1'tt�4'nel"hltil[1Ct ---- -`State.f_tcensc._��
l..iixtnse
tt,"hG-C9UhhL.onuacti1C I "� State.E.iccn;e � 7 ISL 3049
--__—__; C� License
- Reason f0.".nce�lation &L-+r�pr'
I`hc trndcs oi-, cd dotes ht rcby 1Q1"eC l0 Illd.^Rlilify'and t.10W b.1 I less$e Lucie C.uutt[y, its ofl5cer;,a*cr.ls —
eosin, fens or danta cs ari;rng from[u1y and all cl;tien,cif aeeion for any reason, which tree} arise as;I I
cotttrac•Atlrsttbcontractor or caneellaiiort of}tertnit. A permit ctinrrat t>e cancet ed if tiror'k has been ` and cmphtyees from all
exult of ibis change:of
performed.
sic, r�&[ir owNf:K 'or ow"tterrbuildarj ----
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ACTOR(orneLL(;(_'.as appiienbi�l
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S:u(c of f�Io,iifa.CrAIt)Lyor " — " '----
.t Jr LUcla CMhtty
T'hct tit [•:.cLlha;ida.Caurt r
(Ilti\bl❑'1 III J Jti".Cfa W:K il�-: !0 Si.f_u,,ic County
t��o\vlcynl l•ar'L ro nre ihix
I)a ' tlay of_�/�G� iOZ�.. 1^b.,(-rhntv),i;;irt:r rtttrni L �cknou
h�1ure tit r
2-zd,ty0t2[iL�
lbo is f e1,111 11)krv,nt to me
!h;ts produced
t C 7'wbil 112i P -lluced
__. us ID
si ttlre of Noon. -. Date
SignmurcurNotary note —-
:tirbJ?� �041"7eublrc Slate or Flonda
Hannah E Moore LC_,i
Nola y Public Slate d Flonda
- • MV Ccmmrss,on HHOt7099 Hannah E Moore
�Yd Expires 07/012024 MY Commisson HH Ot7099ExExpires 07r01r1024
I
DO 01 2022
1T County
-rnitting
E
IT#
ISSUE DATE
- - - PLANNING & DEVELOPMENT SERVICES
0
Building& Code Compliance Division
- - BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
-Ehman Electrical Contractor, LLC have agreed to be
(Company Name/Individual Name —-P )
the Electrical Sub-contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) (Primary Contractor)
For the project located at7Q�G` _ -t-.��- t ee�-i
(Project Street Addressor Property Tax 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.
CONTRACTOR SIGNAT('RE( ualifirr) SUB-CONTRACTOR SIGNATURE(Qustirier)
W Bryan Adams Timothy L Ehman
------ '
PRI\T NA:11t -.
29179 ___ __ 31748 _
COi•KTI'CERTIFICATIONNC',NIBER - C_Ot;NTI•CERTIFICATfONNt,,NfBER� --
State of Florida,County of St Lucie ST LUCIE
— —•-- State or Florida,County of {
The forcgoigg instrument ii as signed before me this�b dayf The foregoing instrument wss signed before me Ibis d'»q( ?
W. Bryan Adams
,..
- ry ZZ .
__ �.... _ c ? ,20_ by Timothy L Ehman
who is personally known or has produced e _ - tvho is personate known or has produced a
as id lification_ - ---
as)dratifies ton.
_.._ _ - _... STAMP
Si at ar u lie Signatureof Notary Pdblic s� ` — STAMP
f
P nt Name of N ary Public �\\\1111111Hitirjr���� Print Ne�r o Nota Public
`\ �Go� OHOi• //�
{
2oc'r�u� op0°vo Notary Public State of Florlda
�; Laura Townsend
� My Commission 1
Revised I U1fi 2016 Z :o gy9106177 * +? odP . 175435
i� • oin Exp.9/13/2025 i
i 9F�•yAo�drrd thin ♦��`.' p�� �,•.c�vv-�.
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