HomeMy WebLinkAboutchange of sub contractor J'V
APR 0 2022
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PLANNING &DEVELOPMENT SERVICESr. Lucie 000"t\,
BUILDING & ZONING DIVISION
® 2300 VIRGINIA AVE
• __ FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1578
HANG
TRACTO SUBCONTRACTOR OR CANCELLATION OF PERMIT
C E OF CON
the property owner,
I, AS SELECT ONE OFT FOLLOWING= a of Contractor is to be signed and notarized by P P
CONTRACTOR Chang application must also be completed with new
_CHANGE OF CONTRA Per
and the new contractor a record for the current Permit. A new Pebe must be submitted prior to
d signature. A new Notice of CommencemeAnt must recorded copy must the new contractors name
contractor information an 500 ($7,500 if A!C Change out).
for job values greater than $2,
work.There is a$50.00 fee for the Change of Contractor. completed by the general contractor.
commencing any OR�Subcontractor changes are to be comp a of Sub-
X CHANGE OF SUBCONTRACTOR
UBCONTRA� Form.There is a$50.00 fee for the Chang
The n>�r subcontractor must fill out a Subcontractor Agreementpermit is acceptable only if no work has been done.
Contractor.
The cancellation of a p qualifier of record. There is no fee for
CANCELLATION OF PER T notarized by both the owner and
Ca—nation of permit is to be sign
ed and cancellation of the permit.
Permit Number'
Date: -5/30/7
32� Ve5 pe re, 5
Site Address: �Z�q 77� SLC License �.-
' 1 L "i � State License�r1nC #
Original GC,subcontract r ownerlbuil er 5CY4r�
State LiceLC License s— ---- j
subcontractor =
Contract Disputes --� Bea from all f
Reason for Cancellation its officers,agents and employ
ed does hereby agree to indemnify and hold harmless St Lucie County, arise as a result of this change of
The understgn and all claims of action for any reason,which may
costs,fees or damages arising from any ermit Cann cancelled if work as been performed.
g�t�a bcontractor or cancellation of permit.A p i
eto ,/!:✓ 1. GC applicable)
_ _... CO CTOR(or
n
_ pCiRE GENERAL
of OWNER(or ownedbuilder) �/
SIGN �tti.j �--
W.Bryan Adams PRINTNAME_,_
PRINT NAME -- ----—
State of Florida,County of St.Lucie County
state of Florida,County of St.Lucie County The following m trument was acknowledged before me this
The following i1n'stnrmeut'uas acknowledged before me this
- day of 7 20 1by "S:fin-.
�'O _day ofJ� 20Z�,by :O_ !�`� ,r who is personally known to
,�L.•__vtho is personally known to me as JD.
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.1Z Si stare of otary Date �� SSION �i�
glpa fNotary ate`O GH27,?Fr°''• '�i `� ,•.. G,O�}_(LGH2I?FOr°i�{•�'
Revised 04f%51'16 �>Mr •�• I �e� * }
• WH 106177 rr
i 100177
V""�Z'C srnt of �` % � d�°41h�(Ito Oe`�
%i ,����Of II
FPERMIT# ISSUE DATE
PLANNING& DEVELOPMENT SERVICES
® Building& Code Compliance Division
BUILDING PERMIT
SUBCONTRACTOR AGREEMENT
((;ompany Name/Individual Name) have agreed to be
the HVAC
Sub-contractor for Adams Homes of Northwest, FL Inc.
(Type of Trade)
(Primary Contractor)
For the project located at S 3 U� CIA- �D�
� 1 erce R_ 3 y?S1
(Project Street Addre or Property T
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.
OIISIGNATURE(QuallIIer) 1� %/ `�.,_�.•�---�� t
SUBCONTRACTOR S[GIPCTURE(Qualifier)
W. Bryan Adams
PRIM NAMEPIUNTNA `� /tr�.
29'179
COUNTY CERTIFICATION NUMBER
COUNTY CERTIFICATION NUMBER
Stale of Florida,County of St Lucie i
State of Florida,County of ST I r r
The foregoing instrument was signed before me this Je of i
7 Y The foregoing instrument was signed before me this 3
.Q'ae9of
.�. Y �/a4�✓1 �''� l�rr50Yl '
who is personally known or bag produced a
who is personally known ✓or has produced a '
as id Cation. ;
as i e tiIIcation.
�
Sig nture of Pjotary Public STAMP1111111111 STAMP
. VAI \\\\\\\\\\\,1 S r� r/,, Si lure of ofary public \\\\\11111A ST
Print Name of Notary Public •• � SWJ
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::�� QGH2)��2��.• P ntNameofNotaryPublie `\ •c,.�H'27
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z z #IHH 106177 •#S * • ��� *� i
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* <•••"Alit Under?.• OQ �� .� a N e• �p
Revised 111 2016 •••IC,STATO' i99�?•AudAtled
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