HomeMy WebLinkAboutchange of sub contractor (2) PLANNING & DEVELOPMENT SERVICES P-E-'Cr: ''-JED
ILI BUILDING & ZONING DIVISION LF• 2300 VIRGINIA AVE APR 01 2022
FORT PIERCE, FL 34982 5T. Lucie County, Permitting
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTO SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWAiG
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.
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 far 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: 3a�Zz
Permit Number: 6'P9 9
Site Address: 23 �•�a�'
�� State License b'�C 1 Z �{7 7 7 SL Original��,su��tlt�orrwner/buil er C License
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l New GG;sState License %c LC License _3
_ subcontractor -- _ --
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Reason for Cancellation Contract Disputes
The undersigned does Hereby agree to indemnify and hoIa 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
�traetorfs bcontractor or cancellation of permit.A permit cane cancelled if work as been performed.
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�-•SiGN# OFOWNER(orowner/buitder) �� � A rv�•--•_- � ����—'�^�
fG1¢ TUBE GEAIERA[CO CTOR(or new GC,as applicable)
PRINT NAME W.Bryan Adams
PRINT NAME„_
State of Florida,County of St.Lucie County
¢
The following iasirtrment was acknowledged before me t State of Florida,County of St.Lucie County
his '
a slowing ins wt was acknowledged before me this I
day of- 20ZZ i
2 Y
�^'—S.�—wiw is personallylmown to me
or o has p .as ID. who is personally known to 7
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✓SiQna f 1Votary � .�'• ;�Y/ i� �. �� aPSA S"A /
' H 27O � Signature of otary Date ����, ••'OA1SS10N
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PERMIT# L==
ISSUE DATE
PLANNING &DEVELOPMENT SERVICES
B® ullding& Code Compliance Divisi®n
i BUILDING PERMIT EAPR
�E1�'ED
SUB-CONTRACTOR AGREEMENT
01 2022
ounty, Permitting
(Company Namellndividuat Name) s, 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 '93z3 A--,-4 �c -j %
(Project Street Address or Property Tax ID#I) I �—
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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�CONrI�CrODt SIGNATURE
SUB-CONTRACTOR SIGNATURE(Qualltier)
W. Bryan Adams r r f
PRINT NAME
PRINT NAME
29179 _
COUNTY CERTIFICAT NNN NUMBER �
COUNTY CERTLFICATION NUMBER
State of Florida,County of St Lucie i
State of Florida,County of STD
The foregoing instrument was signed before me this f
Y The f egoing instrument was signed before me this day of
who is personally known Y or Les produced a �
who is personally known ✓or has produced a
Sid Calton. ,
as 1 e dflCatton.
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Sig ature of lQotary Public STAMP
TAMP
\\\\`\SII Si lure of otary Public IA ST 111111,14f,
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Print Name of Notary Public ` •. H P) o�'. OXO /z i
ut Name of Notary Public `V���H 27 z Oi•• !
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