HomeMy WebLinkAboutCHANGE OF SUB-CONTRACTOR f ,
PLANNING.& DEVELOPMENT SERVICESEAPR2022
BUILDING & ZONING DIVISION ;�rmitti n
2300 VIRGINIA AV
E
FO
RT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTO SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWitk,G
CHANGE OF CONTRACTOR-Change of Contractor is to be signed and notarized by the property
and the new contractor of record for the current permit. A new permit application must also be completed with knew
contractor information and signature. A new Notice of Commencement must be filed in the 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 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 the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: - 3 �ZZ
Permit Number: Zl0 ? 8k.53
Site Address: 23 0-? w-a�� �;r �� �e cc-e
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Original GC,subcontract r owner/bui2 er State License h'�L, Z 7 7- SLC License
i 11 GIS4� r^ tl tate License(! LC License �>L-
New-GC,subcontractor _
Reason for Cancellation Contract Disputes t
i
T h`u„dc,s,gr►ea'noes hereby �.J•.^-- - _+..`�agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all i
costs,fees or damages arising from any and all claims of action for any reason which
may c etorfs bcontractor or cancellation of permit,A permit esaa t'la cancelled if work arise
been result of this change of
performed.
i
� i
F OWNER(or bwner/buiider)
jIf'I�A7 IJRE GENERAL CO OR(or new GC,as applicable)
PRINT NAME W.Bryan Adams !PRI -
NT NAME /3
A t�G.L,
t
State of Florida,County of St.Lucie County State of Flarida,County of St.Lucie County
'khe following instrument was acknowledged ed before
8 me this The following instrument was acknowledged before me this
20�,by✓=t (1 i Geri^ Zt Zy of 20 —
' 4by—�s?C b e
�` c rn—S__wfio is personallylmown t_�ure' 1
or o has p as ID. `�` r �-' —who is personally(mown to 1
ttte
has
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�Sigrtatur fNotary "�•`.�' _ .�� seSTq(Fy����
�\ a Signature of otary (Date ���� .•�yA1SSI0N '•. ��
Revisrid 04fi5f16 * . �.� ;*� S*••� �`r N•
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PERMIT#
=18-SUEATE
PLANNING &DEVELOPMENT SERVICES
® Building& Code Compliance.Division
® BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
I _1C; 1,
(Company Name/individual Name) have agreed to be
the NVAC
(Type of Trade) Sub-contractor for Adams Homes of Northwest, FL Inc.
® (Primary Contractor)
For the project located at O �a fff�7r(Project Street Address or Property Tax D
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.
:e����ORkG�NATURE
SUB-CONTRACTOR SIGNCTilRE(Quatllier)
W. Bryan Adams
7
RINT NI
PAME
29179
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER j
State of Florida,County of St Lucie i
State of Ronda,County of
The foregoing instrument was signed before me this36 day of The for going instrument was signed before me tbis d of
r 207Z 1�.11.c.. , . a C�c CGS y
20
who is personally knows V or has produced a �
who is personally known ✓or has produced a y
;1def,,J1oo, ,
as i tilication.
s
odtary Public STAMP
\���11111illllfll//�/// Si tore of otary Public
STAMP
C Nx-S lNuuuNl/�//i 3 IrCI � ,� Fy �i�� \\\���
sslpN�. i� L1,1�0.
Print Name of Notary Pubtic ,UGH 27 a'. � � .•' �SSIOlV �i�
�t�P do�,%P�•, �. P of Name of Notary Public •p GH 27- i•• 1
i�.�'d. do �y.'Q 2.Z 1if1Fi 106177 S
�� �/• iypi yA�bltic
Revised 1I/16/2016 ' �jI C j 11 Nod O\``` W/Je��.
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