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HomeMy WebLinkAboutchange of sub contractor i PLANNING & DEVELOPMENT SERVICESERECEELIVED BUILDING & ZONING DIVISIONow 2300 VIRGINIA AVE R 3 1 2022 FORT PIERCE, FL 34982 (772)462-1553 FAX 462-1578 County, rnr�nittire- CHANGE OF CONIRAgCTO&SUBCONTRACTOR OR CANCELLATION OF PERMT PLEASE SELECT ONE OF THE FOLLOWING CHANGE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the property owner, and the new contractor of record for the current permit. A new permit application must also be completed with new 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 Asa$50.00 fee for the Change of Contractor. K 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 cancellation of the permit. for Date: �i(�&Z Permit Number: 2(U 7- 0°(Cd Site Address: �ZvZ /" "�GiG.�•o •r.�• I t� �L 3 ( SI 2` �� ��'`�_?AState License frY�L'1ZL�77-7 Original GC,subcontract r owner/buil er — SLC License i - State Licens LC License IVew.GC;subcontractor - --- -- i 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 i 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 ___SP,ntmet bcontractor or cancellation of permit.A permit cann eaheelled if work as been performed. i SIGN - OFOWNER(orownerPouiider) ____ ��•--•••- - ^- NAME Bryan Adams 'Sit'2�A71JRE GENERAL Co CTOR(or new GC,as applicable) PRINT W. PRINT NAME�_}�2,:�= i State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County The following instrument was acknowledged before me this The following's t was acknowledged before me this j Y of eteGt. ,20�,by (!rn day of� 20�by _s: a, 3 rn-�_wfio is personally known to me or o has P. a..as ID. Q�1 who is personally known to ;\`���1111111111111// A't"-Of PGWY cd as ID.Slgnaf NotarFate .••' sio•'' ��� �`1S Ni� Date �� SSION •'Va GH27o i •'•�tSN i Revised G9l Sl l6 _ � •� � ���`r * • AM#I 106177 •* *• •* zt i p••o �e:• S y•Z dliH 106177 Q S 3 9•��f o°ddedlb�� i�°:�O`� �0.�•'�v 6° N �e`y: ii�.p/ 4AlicUnda� 0��� 9 •s'FA- ,o oded% (�,• /1111111111111 FPERMIT# 1 D _ © n ISSUE DATE op INNI—M-011�1-- ml PLANNING&DEVELOPMENT SERVICES a wilding& Code Compliance Division RE%r-'E VED BUILDING PERMIT MAR 31 Lu'C2 SUBCONTRACTOR AGREEMENT ST. Lucie Count,,, i erinitting ilk =�h (Company 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_ ZbZ L.'r-fC4 (Project Street t;ddress or Property 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. /�� ✓ 7 / C�NTI�,CI'Olt SIGNATURE(Qualifier) �— ��•t` 1A, SUB-CONTRACTOR siGRATURE(Qualifier) YN. Bryan Adams � �• PRINT NAME PRINT NAME 29179 _ COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER j State of Florida,County of.St Lucie State of Florida,County of ST �� The foregoing fostrumeat was signed before me this�U as of .�,_ i y The foregoing instrument was signed before me this day pf �Ck 20�Y�,11,�. ~F ns y� ,/�(I�rGI.\ 20ZZby AD, �' r5 o r-1 s who is personally known V or has produced a { who is personally known ✓or has produced a as id cation. as I e tification. s St g nture of i)jotary public STAMP � / \\\\\\�SII STD ///,/ Si tureof otary Public �IIIIIIIIIIIS AMP .Fy yi C�Ir0. \\\�\\\\gpStA,STA(�cy/��� Print Name of Notary Public ` �SiS�No�•..• /% p nt Name of Notary public �\ ••p. tSH 2 NOi�•. � .aS 1s Z •, d �y • :y #HH 106177 Revised 1111fi/2016 �� '�/ �.c•llode •\p2`�� e OF �''a do N �e`q%�p3� ////// INI 1 1111 ONE\\\\\ IIIII i1111111N , 1