HomeMy WebLinkAboutchange of sub contractor i
PLANNING & DEVELOPMENT SERr�` �a�� �11 0
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE APR 0 022
FORT PIERCE, FL 34982 cie COl.+nty; +^ar�iittinc�
(772) 462-1553 FAX 462-1578
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CHANGE OF CONTRACTOR-SUBCONTRACTOR OR CANCELLATION OF PERMT
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PLEASE SELECT ONE OF THE FOLLOWII�IG
CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the property owner,
tra
contractor information and signature. A new Notice of Commencement
and the new conctor of record for the current permit. A new permit application must also be must be filed in the new completedcontractor's
ws name
ith new
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.
K CHANCE OF SUBCONTRACTOR—Subcontractor changes are to be completed by the general c ntractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a$50.00 fee for the Chang of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has b en done.
Cancellation Of permit is to be signed and notarized by both the owner and qualifier of record. There is 6 1 fee for
cancellation of the permit.
Date:
Permit Number: _0106—V74
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Site Address: A. K c—ft-6 e re- 3y/4�1
State LicenseA'�C 1 Z�I 7 77 SLC License
Original GC,subcontract r ownerlbuil er --� l
State LicenseSLC License New.GC,subcontractor - -- - --
treason for Cancellation Contract Disputes
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The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employe
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change or
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traetorfs bcontractor or cancellation of permit.A permit came camcelled if work asbeen perforrloled.
� Of'OWNER(orbwner/builder) i f �''�'�
IrCj2QATURE GENERAL CO CTOR(or new GC,as applicable)
PR?NT NAME W.Bryan Adams 'PRINT NAME "1
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State of Florida,County of St.Lucie County
State of Florida,County of St.Lucie County
Thee following instrument was acymowledged before me this The following instrumen was actrnowlodged before me this 3
3v'"day of G.�d ,20?by C T 73�y of rt� ,20��by
C` �^ S w1w is personally]mown to me #
or o has p as who is personally"no— to
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PERMIT#
ISSUE DATE
PLANNING & DEVELOPMENT SERVICESj
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® Building& Code Compliance Division - - -
BULLDING PERMIT
SU13-CONTRACTOR AGREEMENT APR 01 , 022
! ST. Lucie County lPerniitting
(Company Name/Individua!Name) have agreed to be
the HVAC
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(Type of Trade) Sub-contractor for Adams Homes of Northwest, FL tpe,
(Primary Contractor)
For the project located at �� S�K 9.A c
(Project street Address or Property Tax IDI#)1 le6C 5�L 3
It is understood that,if there is any change of status regarding our Participation with
h the above mentione
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.
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ON=rR�G'T02SIGLVATURE(Q.,�un,.r)
iBUB-CONTRACT®R S Gi R1CT R�•�� �,.f I � i
W. Bryan Adams - (Quallner) j
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29�7J t'RINTNAME �� ���•f'� _
COUNTY CERTIFICATION NUMBER
St Lucie COUNTY CERTIFICATION NUMBER
State of Florida,County of
The foregoing instrument was signed before me this 3d State of Florida,County of gT r t
(t: day of The foregoing instrument was signed before we this I i
20by L ��ll��. `7—�, deli f
who is personally known Y Or hes produced a ZO O n - O r-
as id who is raona9y(mown ✓or has produced a
cation.
as 1 e titication. v
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Sig ature of lyotary Public STAMP
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