HomeMy WebLinkAboutchange of sub contractor (2) PLANNING & DEVELOPMENT SERVICEEAPR
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BUILDING & ZONING DIVISION 1
2300 VIRGINIA AVE 0 I c�FORT PIERCE, FL 34982 unty :yrri7itting ,
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF T HE FOLLO G:
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 (S7,500 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 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: 6/22- Permit Number: Z(6`�- (�S&(Q
Site Address: Z�'( Ar.-�,v� to
�� 1 1' �`"'�'l�` G State License� '�L 1 Zit 7 77 SLC
Original GC,subcontractor r ownerlbuil er License—
Eli l�Z l.% 11 1—� State License l 1�� ( SLC License New GC,subcontractor -
Reason for Cancellation Contract Disputes
1
The undersigned does hdreby agree to indemnify 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 t
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cgntr�ettm's bcontractor or cancellation of permit.A permit catin :;;
work as been performed.
�---SIGNAL OFOWNER(orowner/buiider W�� � ���`CO CTOR(ornew GC,as applicable) i
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PRINT NAME W.Bryan Adams PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County ,
;The fol owing ins ent was nelmowledged before me this The following in t was aclmowtedged before me this
of�,202Z,by Ly;(l i� Y of 2Q2-4b y �•'a�ar1
t �-e t_S_ _who is personally(mown tom_ 1
— ' r _o,�. who is personally Imown to !
or o has p _. as tr3.
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PERMIT# :
ISSUE DATE
�- PLANNING &DEVELOPMENT SERVIC
® Building& Code Compliance Division RECEi F�D�
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BUILDING PERMIT APR 01 2022
SUBCONTRACTOR AGREEMENT ST. Lucie County, P-annittincg
(Company Name/Individual Name) __7 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 �Z A t...a�-� ��c F-4 ?(e<<C �L 3'z(Cr51
(Project Street Address or Property I ax 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.
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COMW %
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ORSIGiVATURE(Qualifier) c �-�� —�—�'
SUB-CONTRACTOR SIG TURF(Qualifier)
W. Bryan Adams
PRINT NAME
PRINT NAME
29179
COUNTY CERTIFICATION NUI4IBER `������
COUNTY CERTIFICATION NUMBER
State of Florida,County of St Lucie
state or Florida,County of
The foregoing instrument was signed before me this 376 day ,.
-��77 y The foregoing instrument was signed before me this,day of
acc�� 20`, y L�>.l\ ' L Cal mlti Z2_
20_�by \f�S��✓1 �' 1(�rr50Yl
who Is personally knows
Y Las produced a /
--or who Is personally kq°wn ✓or has produced a
as id cation. — t
as i e tification.
STAMP
Sig .tore of lYotary Public \ 11111111I/ STAMP
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