HomeMy WebLinkAboutchange of sub contractor PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
• 2300 VIRGINIA AVE FRECF-11V
FORT PIERCE, FL 34982(772)462-1553 FAX 462-1578 1 2022
ST. Lucie County, ;��rinitting
CHANGE OF CONTRACTO SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOMOG
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 is a$50.00 fee for the Change of Contractor.
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 Sulu
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: Permit Number: —Oc'(O
Site Address: 5 Zy G vtc 'C�+o
�tract
State License t;AAC�ZOriginal GC,subco r owner/buil er - 7 7 SLC License
t �r c-h Buz t ir`K;1 LL State License-- Z� l fj>I`f Sr�;-SLC License ! 'New GC,subcontractor - - - - -
Reason for Cancellation Contract Disputes
The undersigned does hereby agree to indemnify and hold harmless Si Lucie County,Its officers,agents and employees from all 3
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 f
�etorfs bcontractor or cancellation of permit.A permit carom 7sb, canceped if work as been performed.
� i
StONA OF OWNER(or ownerlbuilder)
SI ATIlRE GENERAL CO CTOR(or new GC,as- licable
PRINT NA14E W.Bryan Adams _ /� `, aPP ) ,
PRINT NAME� z.S= `l Lrft j 4i# �i 1
- i
State of Florida County of St.Lucie County State of Florida,County of St.Lucie County
The following insb=cnt was acknowledged before me this
day of tG� ,20 Z b .Je.9 lowing ins was acknowledged before me this•C� i
_�, yJitrn day of CG 20IZby
'�- _who is personally(mown!o me
is personally known to
or o hasp ID. g
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�S atur fNotary ate r�i,,�� ����� p,RASrq�Fy
•• tdSSION i� SI store of atary Date ��� SSION• ��i
Revised 09f'45!16
4W 0-0OM 106177
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FPERM7IT# O _ ISSUE DATE
PLANNING &DEVELOPMENT SERVICES
Building& Code Compliance Division RED; 1 ED
BUILDING PERMIT N1,4R 31 2022
SUB-CONTRACTOR AGREEMENT
ST. Lucie county, i'•errritting
(Company Name/lndtvtdual 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 '�2_2jD 6 Aa ���� �-�— 1e`� �L 35
(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 Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
i
✓..7�
ORSiCNATURE(QualfIler) t
SI7B-CONTRAC FUR SIGNTTtJRE(Qualifier) !
W. Bryan Adams
PRINT NAME
NAME
29179 _
COUNTY CERTIFICATION NUMBER
COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie
State of Florida,County of _
The foregoing instrument was signed before me thiGII� s
day of The foregoing instrument was signed before me this�i7�aY of
by 1�._.2o� 1\�. J C lc�,� Grcln
26y_
who is personally known zor has produced a i
who is personally(mown ✓or has produced a
as id Cation.
as i e Mention.
SIg nture of lYotary Public
STAMP
/ SNWASTAZ f�///// Si hereof otary Public �1►11111111f1%AMP 0
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�MAL � '•• S51t)N �i
Print Name of Notary Public ` :, �l;H 2)4A'• �� Q'r0. �� .•' 1SSIt)lV o ��i�
�P pa•P�, Z Print Name of Notary Public • v UGH 27 i f
e ' S may•
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Revised 11116/20I6 �j/C TATEO;X���\` l;ST AIS OF
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