HomeMy WebLinkAboutchange of sub contractor PLANNING & DEVELOPMENT SERVICES RECE7VED
•
BUILDING & ZONING DIVISION MAR 31 2022
• 2300 VIRGINIA AVE
FORT PIERCE, FL 34982 ST. Lucie County, Per��itting
(772)462-1553 FAX 462-1578
CHANGE
OF CONTRACTM SUBC
ONTRACTOR OR CANCELLATION OF PE RMT
PLEASE SELECT ONE OF THE FOLLOW- 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 to new contractor's name
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. oPy 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$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT-The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized by both the Owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 30�Z Z
Permit Number: z(07'De,cX)
Site Address: 52011
��M�,�su� '+r�` State Licensei;N►C1Z �t 777Origintract �Owne�r/bui �e� � SLC License
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i ` `S!1 t r"' (��; c-h�:z�.i'K;i L1�_ State Lieens %Et'_ e c E t
New-GC,subcontractor �E�ISLC License
i
Reason for Cancellation Contract Disputes
The undersigned does hereby agree to indemni and hold
costs indemnity harmless Si Lade Coun its officer,fees or damages arising from any and all claims of action for any reason,which may arise as a result tof this changloyeese'
all
'contraetor:s bcontractor or cancellaton of permit.A permit cane cancelled if work as-een performed.
LLN �;6FOWNEi(o,�;�i�u�jje__—r) - _ .__ _$f AT[!RE GE �.�. � �`yc��`NERAL CO CTOR(or new GC,as applicable)
PRINT NAME W.Bryan Adams
PRINT NAME.
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 f Mowing in munent was acknowledged before me this
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ffi?L' day of 20'� by� (,l t � 1 day of 40- ,20�by 2j
personally known to me
or o has P _ _ _as ID who is personally known
h� as ID.
lgua [Notary to /i — WA ST,4,t
`� a .o 1SSt0 Signstureof ota \ �•
GH2I i ry Date 1SSIotV •. //ice
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11111
EPER7M1T# ISSUE DATE
PLANNING &DEVELOPMENT SERVICES
® Building& Code Compliance Division
i BUILDING PERMIT L7R VED
SUBCONTRACTOR AGREEMENT
12022ty, Permitting
(Company Namellndividual Name) �_ have agreed to be
the HVAC
(Type of Trade) Sub-contractor for Adams Homes of Northwest, FL inc.
(Primary Contractor)
For the project located at il;701-( /V `6LL4.<<CJLKo � iecce FL 3Zj45_(
(Project Street Address 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 Cade Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
�!MZMOR SIGNATURE
(Qusiitier) SUB-CONTRACTOR SIG URE
(Qualifier)
W. Bryan Adams {
JJ
PRINT NAME flfiyFZ
PRINT NA.HE a � j
t
29179 _
COUNTY CERTIFICATION NUMBER
COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie i
State of Florida,County of STD ,_ }
The foregoing instrument was signed before me this�� day of The f zegoing instrument was signed before me th3s00 of
a<fC� 20. Lby t�.11,�.,� '7 r�•. C 1�,, GCt
J 2Uby_\j�cr�r,�/�r lil�r.�50Y7 {
who is per known Y or has produced a b
—' who is personally known ✓or has produced a
as id cation. -
as 1 e tlfication.
Si STAMP
g nture of lYotary Public \ Ili 1111111 /
Si lure of otary Public STAMP i
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