HomeMy WebLinkAboutchange of sub contractor (2) RKEIVED
PLANNING & DEVELOPMENT SERVICEE
APR 0 4 2022
• BUILDING& ZONING DIVISION ST. Lucie County, i-ennitting
• 2300 VIRGINIA AVE
- FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTO SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWIIJG•
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 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:
Site Address: .�-
t ,
' '�A � State License A'�C�Z `t777 SL
Original GC,subcontract r owner/buil er �----I C License
i
L
i_.ES' li 1 L am_- State Licens f�SLC License New GC,subcontractor -
Reason for Cancellation Contract Disputes
The
undersigned
hereby agree to indemnity and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising fro any and all claims of action for any reason,which may arise as a result of this change of l
�etem's bcontractor or cancellation of permit.A permit cann cancelled if work aT been performed.
�S16IV OFO I__.. :G._ _ t rasa wNER(or oumerlbuitder � z
� ';�ATURE GENERAL CO /CT'ORj(or new GCS as applicable) I
PRINT NAME W Bryan Adams PRlNTNAME��t�,�'lt�tit,l��rit-�y� i
i
State of Florida,County of SL Lucie County
State of Florida,County of St.Lucie County
The following ins ent was acknowledged before me this
e ollo%ving in trttme� was acknowledged before me this
y
203Z byj 1 LC��^ y of. ,20Z2,-by :: a,'�
t ` �^ is personally known to me }
r o.-+_who is personally known to f or o has p __ _ys 1D. i
\\\\�1111111111111//r� meo has ad _—as M.
✓ a f Notary ��ate ��� ,,.. Fy �Wk 7
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PERMIT#
ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
® Building& Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
� I� 4�1���"`- �l•�' �i2f\L�'�I C'r6�f if1Cl L-I--�
(Company Name/Individual Name) —7 have agreed t0 be
the HVAC
(Type of Trade) Sub-contractor for Adams Homes of Northwest, FL Inc.
(Primary Contractor)
For the project located at '3 3 Zz �J�-�It 6< -f�- Vc,&,cce F/_
(Project Street Address or Property 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.
:CL=1MC_TORSlGfNA=T1n1V1.ualtuer) SUB-CONTRACTOR S Gi NTTURE(Qu 1 alltier) i
W. Bryan Adams f. 1
PRINTNAME 1%.Zf �'
PRINT NAME
29179
� ! I
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMB ER
State of Florida,County of St Lucie !
State of Florida,County of ST r t
The foregoing instrument was signed before me thisda of �`
y The foregoing instrument was signed before me tb'is3&of '
J------- 2Q_-by
who is personally known Y or has produced a
'— who is personally(mown ✓or has produced a
asid cation. i
as t e tification.
s
STAMP ;
Sig ature of Ijotary Public 1111111f11 t
Si ture of ota Public STAMF
rY `\\\NO\N11A ST
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Print Name of Notary Public :y • UGH�No�•, a�0. �� ••'• tS510/y
P nt Name of Notary Public :�G UGH 27?Fo�Oi•' Z !
AHN
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