HomeMy WebLinkAboutchange of sub contractor '- J. PLANNING & D.EVELOPMENT SERVICES
BUILDING & ZON NG D-IVIS.ION RECEIVED -
-. 2300 VIRGINIA AVE
FORT PIERCE, FL 34982 APR 0 6 ' �22
(772) 462-1.553 FAX 462-1578
ST. Lucie county, f'erniittinc
CHANGE Or CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF P
• ERMT
i'LEASf $t.LL�."1 ��1VL t -•1•LL J( QVVrt ty(j:
CUANGE OF CONTRACTOR-C dance of Contractor
and the new c r [or is to .Q
o thac•tor of record fur the cttrreut perrrtil:. A new permit be sr`Itcd and notarized b}•the property owner,
Ile
contractor information and si�nafxne. A new Notice. oECurttntencerttentpmlcisttbertlirledyin !so be il>L corlIpleted
for job values greater than S2,500 ($7,500 if A/C Change_out). A recorded copy must be Submitted
C011llUcnCIng any work. There is a $50,00 fee for the Change of C:oarh actor.
prior to
x CHANGE OF SUBCOI\'1'RAC'L•OIZ- Subcontractor changes are to be coFnpleted by the general contra,
The new subcontractor must till ouf a Subcontractor Agrreeme•nt For(n. There is a $50.00 fee for the Change of
Contractor, tractor.
sub-
Contractor. OF)'EEZNIIT- 7'Ite cancetfatiott of a iterrnil' is acceptable only if,no wort: h[is been done.
cancellation
of hermit is t. be sT ied and notarized by both the. owner and (ivalifier of record. 7•ttere is no fee. f
cancellation o1•the permit. -
or
Date:
Permit Number: � — 6�
Site:ldclress: _ ��� ----
�— f r ree-
Urit� - ---- -..State.License
-r13wy'�
„wal G( ,subcontrac•loI.or owIler,lttliIder• —_______�:�fLc'License
Netit'�tibcoii�,clilr _State L.icense.]�U -_ i 3 r 9
Reason furCancelltion -
The undersigned doe,hereby agree to indenmily c}nd lat)icd ilarnll8$$fit L{[L'le County, its of�icersrs,a
Costs, rocs or dairm�es arising;horn any atld all claint5 nrat:60 PiTr an r
f cr.ts and employee frnln aft
Ct',ttractor/subconuactor ur ca(,cellaiion o,permit. permit cr►etrlot Ire cancel ed if Nrork has been performed,
re3son> which rrlay aline a,a result of ibis chan$r ill
stci'NrAru1 r ow�,;- IIRl Harzrbu -- StCM1 U��teE�GEIv�EC(3� R --
:- --PRII T O1CTRforni!:% ac applicabiel
Siu(c 01 Fkn'iitu.COWIL"of
1 S( LUCK CMu,ry
The,f-trll,u i
of 1=; -(Ia.C'ountj of5(.Lucie Cuty30 rn(0.IC ACULOAefle(l bark,,Inc(hi< a
i rL �fy ttnh�riF in: r rntrni �,a k-(rw;��.c
-- _fiZ� .. _ ,_ �_ d bet rre r
W- R _`- � � ��d;ry Of
nc.hi:.
- 4tlo is 1,eronallp kro,nt ro rue rn
F,, pr(,dt,ra - -- _ .., �ha is- "else
35 ID. I rxhy knu%m k,
t c. r wk(t ltai pr rduced a;1D,
Sfcn (Lire or Noi�ry
bate ----- -
tYh-K
S(gn,(ureorNotary naic
E11
�� �7�uDlic�$la(e a FlondaHannah E Moore =o���� Noary Public State of FlondaM � Hannah E Moore
Y Com""s,onHH Ot7pgy My Cammiss,on HH Ot7099
orn ExPveeO'/ro1/202a ?w�tr Expres07rotr1024
PERMIT# ISSUED TE
-T- PLANNING & DEVELOPMENT SERVICES
e
Building& Code Compliance Division
- -— BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
Ehman Electrical Contractor, LLC
-- .._.._..- ----_---,_—_- have agreed to be
(Company Name.Individual Name)
the Electrical —_ — — -- Sub-contractor for Adams Homes of Northwest Florida, INC
(Type of Trade) (� (Primary Contractor)
For the project located at 9 lr-al"� t Ci_(1 t—
(Project Street Address or Property Tax ID q -�—
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.
CONTRACTOR SIGNATURE(Qualifier) S ,B - — --- - ---•-- -- ____
[ CONTRACTOR SIGNATURE(Qualifier)
W Bryan Adams Timothy L Ehman
PRINT NAME -- -- --
- - ---
-_ - - PRIST NA:tiIE
------ -- ------ --—----- i
31748
COUNTYCERTIFICATION NCMBER -
C—OU\Tl'CERTIFICATfON N['dfBER
State of Florida,County of St Lucie ST LUCIE j
-"--- State or Florida,County of yI_
The foregoing instrument iiass fined before me this /+D-day of The foregoing instrument was signed before me this ,la or f
W. Bryan Adams 7-Z --
t/ ,z by- _-- ct.rc,� 20 b, Timothy L Ehman
who is personally known Ytor has produced a _ _ t+•ho is personalh known�or has Produced a
--- - ---
as id liricalion. as idrnHfica ton.
_... _. . ---.... STAMP G� �blic—
PSTAMP
Si at orN ar u lic MP
lurcorNotary ni Name of N ary'Public \111111IftftMf/// ry
STD` /�i/ Print Nemr of Nota Public
Fy
Gplh� HAi.
=oPP;Yq,, Notary Public State.of Florida
Laura Townsend j
Revised 11116R016 — K; , My Commission
Z:2 #HH 106177 * + dQ HH 175435 '
i 0 S. d y ` y ?o�n� Exp.9/13/2025
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