HomeMy WebLinkAboutchange of sub contractor (2) Muni= Elvi
PLANNING & -D.EVELO1'.t ,. NT
ME. ERVI
•
BUILDING & ZONING DIVISIO.�- ' *
• 2-300 VIRGINIA AVE I APR 06
FORTPIERCE, FL 34982 ST. Lucie county, re,
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR
I01\ OF PERMIT
PLEASf_-',SE1,E0 .)Nc 01-MIL'FoLi-owiNg:
—CHANGE OF CONTRACTOR—Changge.of Contractor is to be signed and notari7ed by the Property owner,
and the new contractor 01f1-ccord for the 00-i-rent permit. A new permit application must Also be completed with
contractor informatiot, and Si-.0naftll-C. A new Notice of C
tbr job ValUes Or -0millen cemen I m[L%r be filed in the new conti,
,realer than $2,500 (57.500 i actor's name
collullencin"' aL'Y work. There is a $, if A/c Change-out). A recorded cOPY must be submitted riot to
_50,00
fee for the.Cluinge Or Contractor.
Y, CHANGE 01.-'SUBCONTRAC,f-011--Subcontractor changes are to be C0111pleted by the general
The new subcontractor n1LISt fill Out a Subcontractor Agreement Form. There is a$50.00 fee ' 0 C.
Contractor.
Contractor. for the Change of Sub-
-CANCULATION 017 1'ERN111'_ The canceffati,)n of
Is'acceptable only if no wol-1, hasas been. done.
Cancellation of Permit is to be siLrncdpermit
ancellation of the permit. and notarized by both the owner and qUalifier Of'record. There is no fee fo
r
C
Date:
Permit Number: 6"(60
Site Address: F
S+ =�_4
Original C . Statc License
01,0�vlle (jer --State PLC'L'icellse
GC,subcontractor State U ISLC License
Reason 1,01-C".111cell'ition
The Undersigned does herob
008LS, Pecs or damuqj) -pl-eO 10 illd,'llinif�and 1,1()Id J)irnl CS's St Lucre County,its 0117rcer3,a'
,es Ilrislnoa i'torli any a7ld all clahn-S rlrac6otl 6or anN reason,which n and employees froth all
or cancelliloll Or arise as H I-esl.lft of this c1linge.(.)f*
1),01171tt. A pet clIlIrlot be cancel � Performed.
ed if work has been
N A N.E
U
swcor Florida,Canary of St.I_JtCie.00J)I!Jv
IMtidii.Ciurity of St.bivic
Guy tY
�6 In) acknowi-dged bel�,re me Ihi.�
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ay(f
Wor . R jf
10fD has rrudI;qCd_..___ ss 1-imoridly knov.11 to
ID.
rT.JWWAJ(',_ I C "wbl)Ila p iduced uS ID
Sign litre of Notary
bale
S[grttturc.of Notary Dare
4,", rYeubltc State of Florida
Notary Public state of Fioncia Hannah E Mooreoty Hannah E
W "t Lo
n h Public
My is--H H 01709--
0
Hannah E Moore
--ve" My Commission HH 017099 My Commission HH 0 17099
xp s '0 Jr 20
c'
F� Expires 07101f2024
Exp,res 0710lr2O24
PERMIT# ISSUE DATEF _
PLANNING & DEVELOPMENT SERVICES
Building& Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
-Ehman Electrical Contractor, LLC have agreed to be
(Company Name/Individual Name)the Electrical -- _ - -- Sub-contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) (Primary Contractor)
For the project located at �1f'-1 t 0 p
(Project Street Ad(Uss or Properfy Tax ID fi) —
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 SIGNATURE ualifierl St'R.CONTRACTOR SIGNATURE(Qualifier)
W Bryan Adams Timothy L Ehman
PRINT hAiNE PR(KT
�..
29179 31748
COUNTl•CERTIFICATIONNt.NiBER—"-----..... -- - ------- -------- ------- -
COL�NTI'CERTIFICATION Nt'AIBER
State of Florida,County of St Lucie ST LUCIE
-•�_ State or Florida,County of
The foregoing instrument��as s fined before me thls3c dad•of The foregoing instrument Has signrd before me this Ili i
�L.�l^ Zo . W. Bryan Adamszu��lry Timothy_I_L Ehman
- -- - i
n ho is personally known �or has produced e _ svho is personally know n or has produced a
as id lification. as ldraHfica ton.
STAMP _ STA�1P
Si al r of V ar a lie - 5igna arc or Notary Public
i
P nl Name of N ary Public �SP Sh11// Print Neme lquo Notary Public
20
Zh: Z �jf°Oo Notary Public State of Florida
* _ ?° �; Laura Townsend
My Commission
Revised I I116-2016 Z:o YI106177 HH 175435
0�'.d 5: = Exp.9/13/2025 i
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