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HomeMy WebLinkAboutCHANGE OF SUB-CONTRACTOR 3-30-22 PLANNING & DEVELOPMENT SERV ICES BUILDING & ZONING DIVISION - 2300 VIRGINIA AVE REC`YVL4 FORT PIERCE, FL 34982 MAP ? ?;^? (772) 462-1553 FAX 462-1578 ST. Lucie COunty, Permitting CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PE RMT PLEASE SELECT ONE OF THE FOLLOW--II CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the Property owne and the new contractor of recordP r for the current rty nt permit. A new h new contractor information and signature. A new Notice of Commenc permit tPmlust benfied in ust also 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 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. Permit Number: 2(67— CF(q Z Site Address: , l�, � V e ec'G�y_� St ate Lice 1 nse�k�L Z Original GC,subcontract r 0�vneil er — 777 SLCLicensei t' 14/1so1 ��,�} f State License• >>t✓.� 1`/ �f C SLC License 3 New GC,-subcontractor J ---_-- }. Reason for Cancellation Contract Disputes The undersi a ...��y ,Ge to indemnity and hold harmless St Lucre County,its officers,agents and employers 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 etoir`s bcontractor or cancellation of permit.A permit camn cancelled if work as been performed. wA1ER(or ownerlbuilder) $I ATURE GE � �^>`1ERAL CO CTOR(or new GC,as applicable) PRINT NAME W.Bryan Adams PRINTNAME��}ct, ' State of Florida,County of St.Lune County State of Florida,County of 5t.Lucie County The following instrument was acknowledged before me this Th,, - .P �f ins t Was acknowledged before me this y personally]mown to me or o has p � �, who is personally known to \\\\\111111111111///// mCo has ed --as M. ? / M11111111111I1// Sgnmtitr [Notary ''••: /���i� L�P9A SrACF l Y • O H2) O•• '�� Sigaatureof otary Date ��� ,•� 1SSIolv .• iP�� 'iVG ?� •• y ' G GH2)2 i i Revised ri4/%5 l b � � � •� u m• = � Z Z:•o lMiH 106177 y 106177 •* i ��••d�f eOnded btu °•. �0�� 5 0 �k:�v d ems".••Q ' ��9'P/ pobllc Uoda�• O���� --A 9 •?A°I)ded 1hN i- �/� STATE O\\�ox\\\ s --- /11111111111N f PERMIT# 1 ©� qq - ISSUE DATE PLANNING&DEVELOPMENT SERVICES ® Building& Code Compliance Division CE: F BUILDING PERMIT SUB-CONTRACTOR AGREEMENT MAR 3 12022 ST. Lucie County, Rermittinc9 (Company have ( Name/Ind ve a Y nlividual Name) greed t�be the HVAC (Type of Trade) Sub-contractor for Adams Homes of Northwest, FL Inc. (Primary Contractor) For the project located at 53Z 1 ve5-pef C, `;+1 F+ 1 I ec'ee FL 3 isr (Project Street Ad" D#) n Property Tax I I 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 ��717R SIGNATURE(QuallIIer) SUB-CONTRACTOR S G[ RX`rURE / � ' / (Qualifier) W. Bryan Adams /�, f PRINT NAME J%I"f`Vb'� ` PRINT NA:NE t, 29179 COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER j State of Florida,county of St Lucie i � State of Florida,County of The foregoing instrument was signed before me this Z/67," o{ Y The foregoing instrument was signed before me day of J Y— oI-S0 V ar wbo is personally known has produced a �rl �'1 ll who is personally(mown ✓or has produced a J�� &tu cation. as i e tification. s STAMP d Mtary Public 1111111111 STAMP �Cl \\ ��S�'STA �i4/ Si tore of otary PubHo \\\` A 1SIT 111////�,/ s Print Name of Notary PubHe •• GH 27 EI"o' a'�0. 1 ��� .... �SSIO/y �ii :'�� � �oe,'PF'. Z P ntNameofNotaryPubllc •v GH27oi•• % ! Z Z'.o #HH 106177 ' *S -* • _0 40 7 �Da'.a, B �y.'�� � Z:y 4M106177 o lic Revised 1 111 6/20 1 6 �i ..c•Und06 •, �p ` : / 1111 &ZIC ITOO' n