HomeMy WebLinkAboutchange of sub contractor r
PLANNING&DEVELOPMENT SERVICESFREOLI
'EDBUILDING& ZONING DIVISION2300 VIRGINIA AVER ®FORT PIERCE, FL 34982 = Oun't?'' i'ernittin
(772) 462-1553 FAX 462-1578 _—�`-�'
CHANGE OF CONTRACTOR,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 c
commencing any work.There is a$50.00 fee for the Change of Contractor. copy 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 Sul)_
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 3 (0— �
Permit Number:
f
Site Address:—)e� A-x-
�e� �S
tateLicenseSLCLicenseOriginal GC,subcontract r ownerlbuil t
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-� State Licensee%E l l €,�1�SLC License
blew GC,_subcontractor - - - --- -
Reason for Cancellation Contract Disputes
The unaersi ea does hereby w 'gn y agree to indemnity and Hold harmless St Lucie County,its officers,agents and employees from all `
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 s
torn bcontractor or cancellation of permit.A permit Cann cancelled if work een performed. 3
I OF OWNER(or owner/builder) �IGi¢ATIJRE GENERAL CO �
jj R(ornew GC,as applicable)'
PRINT NAME W Bryan Adams -PRINT NAME �c 5✓'\(ALL "'
1
State of Florida,County of St Lucie County State of Florida,County of St.Lucie County
The following instrument was aftowledged before me tins
A I_ e wmg m�qum` L7 aclmowledged before me this 3
day of- " CG� ,211?Z,by-(J: { U y of JVIa G
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PERMIT# 1 �"'7_ ®s r �ISS7UEETE
PLANNING & DEVELOPMENT SERVICES
® Building& Code Compliance Division 1R E-(-'F-
IVE
BUILDING PERMIT MAR 3 ® 2022
SUB-CONTRACTOR AGREEMENT
;ST. Lure Count,, i'�rmittin
(Company Name/Individual Name) have agreed to be
the NVAC
Sub-contractor for Adams Homes of Northwest, FL Inc.
(Type of Trade)
(Primary Contractor)
For the project located at SZv'z GkG��.�� f� '7ieT�� L 3
(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.
:CL=TWWWR�SII31 (Qualfier) SUB-CONTRAt;d'OR SiGN�TURE f�
/ (Qualifier)
W. Bryan Adams _ f.
PRIM NAME
PRINT NAME
29179 _
COUNTY CERTIFICATION NUMBER C' 1
COUNTY CERTIFICATION NUMBER
Stale of Florida,County of St Lucie t
2 State of Florida,County of ST Lr t
The foregoing Instrument was signed before me Ibis JOf da
day of The foregoing instrument was signed before me this�0}day of
<<'k 20�by L-1-% ,,,., i
2972 by `f��_r_,_-� �'_l,lC�r�Sorl €
wb•�ls personally known Y or has produced a
who is personally known ✓or has produced a j
as id cation.
as I e tillcation. }
Sig afore a(tyotary STAMP Public '
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