HomeMy WebLinkAboutchange of sub contractori
PLANNING & DEVELOPMENT SERVIC' ---
BUILDING& ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982MW
,9
(772) 462-1553 FAX 462-1578 L�'c: _`� knitting
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCULATI N OF --_�
PLEASE SELECT ONE OF THE FOLLO"—'-- APR 0 6
CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarizebytthtj� p®caner,
and the new contractor of record for the current permit. A new permit application - } +.�wr. ,
contractor information and signature. A new Notice of Commencement mustbe filed in also
new contractor's t�e---'i
for job values greater than $2,500 ($7,500 if A/C Change-out). A recorded c
commencing any work There is a$50.00 fee for the Change of Contractor. copy must be submitted prior to
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: 3�0�Z Z Permi
t Number: Z(0 7 O k 62
Site Address: Lu o Rev— SI
State License fX+L Z L 7 77
Original GC,subcontractor r ownerlbuil er _ _SLC License
i
State License
New-GC,subcontractor LC License -
Reason for Cancellation Contract Disputes
The undersigned does
• •ebYagiG:to tnaemmty and hold harmless St Lucie County,its officers,agents and employees from all j
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
�etatfs con actor or cancellation of permit.A permit ca cancelled if work as been performed.
LIN4A_
e OF OWNER(or awnerPouiider) u� IATURE GENERAL CO
(ornew GC,as a
PRINT NAME W. CTOR pplicable)
Bryan Adams '. --`
— PRINT NAME
State of Florida,County oFSt Lucie County State of Florida,County of St.Lucie County
The following instrument was aclmowledged before me this
f The following ins t was aclatowlodged before me this ?
day o ,20 by-�J �i_Gc� daY ofi .20 Z2,.by
�� -�^'t-_�.�—who is persoaally]mown Some
or o bas p - = �--15 who is personally tmown to I
\����111111111111/// me o has ad as ID.
VSlgoa fNotary ��ate .••••��•.• �11iZ� — L\S 1 S7A�Fy
o �H 27?F•1 O•• �� Slgaature of otary Date ��� .• 1SSI Wy• WAi
Revised 04/x5f1 b � •� �`r`n• = t
2' *ffl 106177 •* =
ZO•o �•�= �y�c NHH106177
�i9�`' 046t ceUt Ear •pQ ed lbw ice°• �'�: l
wl 1 STATto
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FPERMIT# ::71S7.SUEATE
PLANNING &DEVELOPMENT SERVICES
® Building& Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
��[J1+1 c
(Company Name/Individual Nam have agreed to bee)
the HVAC
Sub-contractor for Adams Homes of Northwest, FL Inc.
(Type of Trade)
(Primary Contractor)
For the project located at C( p S+
(Project Street PtEcycss or Propferty 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.
:CL=TWWtOR SIGNATURE(Qualifier) -CONTRACT a SIGNATURE GNATURE`r `
W. Bryan Adams (Q
n8Ilrier)
;
PRINT NAME
PRINT NAME i
29179 _
COUNTY CERTIFICATION NUMBER
COUNTY CERTIFICATION NUMBK-R
State of Florida,County of St Lucie
State of Florida,Googly of
The foregoing igstrumeut was signed before me this day of. The foregoing inatrumegt was signed before me this 3t7�t�
20ZZby t I'll, � day of
J � re� 20a,�y_\Ac/�Yl �'1 l�arr50Yl Who Is personally known Y or his produced a as id cation. �
who is peraogaBy known ✓or has produced a
as f e tlfication.
i
i
S1g ature of lYatary Public STAMP
/ Si cure of otary Public STAMP
�§8
\�\\\11111111111//�//Sp,RA ST4J /j/ \\\IIIIIIIIIIIIII/
Fj' Q.rGI \ �SPCA STq( //v�
��� i
ION
Print Name of Na Public �
ut Name of Notary public ,�G UGH 27?/i�•e�
-k .e % ' _ = 41*1106177 :
5 9 '•j'a°oCed t%%O (00�.'Off` Z
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' 1&11b1l1ic11U11n1d1a d
Revised 11t16/2016 � �e� r; .`•� Q�Q
V�/ VZ iol t/ STATE/ r
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