HomeMy WebLinkAboutchange of sub contractor PLANNING & DEVELOPMENT SERVICES
' BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
Ml FORT PIERCE, FL 34982
(772)462-1553 FAX -
AX 462 1578
CHANGE OF CONTRACTOR.-SUBCONTRACTOR OR CANCELLATION OF PE
i
PLEASE SELECT ONE OF THE FOLLO G:
CHANGE OF CONTRACTOR—Change of Contractor is to be signed and
and the e � notarized b tproperty n w contra he ctor of record for the current permit. A new permit application must also be complet d wit anew
contractor information and signature. A new Notice of Commencement must be filed in the new contractori's name
for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted'prior
commencing any work There is a$50.00 fee for the p to
Change of g Contractor.
X CHANCE OF SUBCONTRACTOR�-Subcontractor changes are to be completed by to 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 to owner and qualifier of record. There is no fee for
cancellation of the permit.
Bate: Permit Number: Z I D 6—U ZS l 1
316 Se-� Be ed i
Site Address: t eC u2 F` 3y*S(
r �- State License CAnC Z `f 7 7-7 Original GC,subcontract r owner/buil er SLC License
i
State License(! c' S c. !
_ l� I �1✓ :_��sL � __ _ _�f C License _� t,( '
New GG,subcontractor - _ _
� 4
Reason for Cancellation Contract Disputes
The undersigned does hereby "agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all clai a result of this change of
ic�ntraetons bcontractor or cancellation ms of action for any reason,which may arise as
of permit.A permit casDn t1 cancelled IfZworksbeen performed.
er) I ATURE GE
NERALTOR(ornew GC,as applicable)
PRINT NAME W.Bryan Adams
F
State of Florida County of St Lucie County State ofk7 64 County of St.Lucie County
The following instrument wac aclmowledged before me this The f Ilowing in trtrutent was acknowledged before me this s
3V day of 20ZZ.by�iJ;(l � Yof��,20 2_b II '
is Personally(mown to me
or o has p —�` �+ �- who is personally known to 1
_ .._.-e _as ID. me has
\\\\\NIIIIIII0110 cd as ID.
// /
,Slgoatur f Notary ate.olsBioAl //'�i Slguature of otary Dale ```'\\\\ SOAI
��'pF�GH 2)?� •, • do, TI Di• �i
Revisod 09/:5/l6 =* , �e� * _* • I
�p�o �y:�� .y•y igiH106177 )
i 9•'10f o°ndedtt�`� pie:C` i0.�•:°v dO e�y:Q` 3
��i�P/ • . oDllc Uttds •'ti0���� ed�da��••.0�1i�� q
/Its 1111Ito\\ '
PERMIT'# �1
- ISSUE DATE
PLANNING &DEVELOPMENT SERVICES
^ y �C Building& Code Compliance Division P son
1 BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
-n
A"
Tic
(Company Namellndivldual Name) r have agreed to b
the HVAC Sub-contractor for Adams Homes of Northwest, FL j�nc.
(Type of Trade)
(Primary Contractor)
For the project located at �32_6 5c.,,,- IBC vt e,�e"+,s
(Project Street Address or Property Tax ID##) tT 1 e«e 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.
r
:CL=7VCCr0RDS1_GN (Qualifier) taut-COINv cRACTO SIGNATURE G1P�T RE
/ (Qualifier)
W. Bryan Adams �. J
PRIM NAME
PRINT NAME
29179 _
COUNTY CERTIFICATION NUMBER ��'�i
COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie
State of Florida,County of S_ _ t
The foregoing instrument was signed before me this
day of The foregoing Instrument was signed before me this d y of rb 2o?sy�����V.n 1 i
who la personally known Y or has produced a as id ✓ ;
who is personally known'or has produced a
cation. s
9
'Ie8cation.
i
STAMP ?S[g nture of lyotary Public � -
I \\��11111illllfll//// or otaryPublic
STAMP ,
`���� gp:RASTq� 610, llulffH//�
c YCl Fy ii� `\`����Sp�t0,sTk1
.� , •' ssloro
Print Name of Notary Public ` QGH 27�A�•. a'r0. lz ,• �SSIOp
P ntName otNotaryPubllc ` • V•�GH27i•• #
i
•03-'.05; 6 �e 2:y 0 106177 • i
Revised 11116/2016 � pG•:;b�;c•Unde .•• AP 0
OQ �� %9p d?Aonoed lDblic e �°•
//V/"; \\\\
///lli1111111� �