HomeMy WebLinkAboutchange of sub contractor RKE�VED
APR 0 4 2022
- x-«-� PLANNING & DEVELOPMENT SERVI Lucie County, i'lermitting
SaO BUILDING & ZONING DIVISION
• 2300 VIRGINIA AVE
-- FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRA910-R,SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE
FOLLOW--II
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:
Permit Number: Z(02-0596
Site Address: �7 "`'� ��� t• �- 1 e�� 3
�""'►n State License 1
Original GC,subcontractor r owner/buil e—r Z�`t 777—SLC License
f
- State Licenser/-��'.t ) / r( SLC License Jam '( ( i New GC,subcontractor ,.
Reason for Cancellation Contract Disputes
The undersigned apes hereby 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
iontraetorfs bcontractor or cancellation of permit.A permit cane cancelled if work as-been performed.
��•S►G OFOWNER(orowner%bu'lder �_ j-- r. ��c�c�1•,.
�ICyl¢A711RE GENERAL CO CTOR(or new GC,as applicable)
PRINT NAME W.Bryan Adams
PRINTNAME�ez,�= 'l ( ft•l ! l�
State of Florida County of St Lurie County State of Florida,County of St.Lucie County
110 following instrument was admowledged before me this
*f tr�Ci� The following w t was aclmowledged before me this x
day of ,20�by� 3mrS ay of Lk .20 Z?.by
�` '�^'—�--who is Pcrsouallylmown to me
is personally known to !
or o bas p as lI). the has
_as M.
��gllll I I111//� g
Latta [Notary 'to i `P .•,�FY //i
a .o ,15SI0N '•, ��i Si atureof omry Date ���� S CN
•� �r ;4t
Revised 09/15/16
Z.c tMiH 106177 w. = 2•y #HH 106177 •*_ }
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oelic Uses. 9/ A�elk undgr:'•• O�
111111111111
PERMIT# ISSUE DATE
PLANNING&DEVELOPMENT SERVICES
® Building& Code Compliance Division
WELDING PERMIT
SUB-CONTRACTOR AGREEMENT
Bill A"s A-t•f- have ti
e a(Company Name/Individual Name) greed to be
the HVAC
Sub-contractor for Adams Homes of Northwest, FL Inc.
(Type of Trade)
(Primary Contractor)
For the project located at S W 7 i C—i r �+T wife_ Ft 3 y4-3-/
(Project Street Address or Pro c 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.
d
Ca1VTlZ�CI'OR SIGNATURE(Qualifier) � � /ram-� f-==-._.��"
l
-CONTRACT R SIGNATURE(Qualifier)
W. Bryan Adams r
PRINT NAME PRINT NA.'NE
29179
COUNTY CERTIFICATION NUMBER
COUNTY CERTMCATION NUMBER
State of Florida,County of St Lucie
State of Florida,County of �,��
The foregoing instrument was signed before me thes3" day of The foregoing instrument was signed before me this �"day of
Zp�y
.r C_5or-
who Is personally know,Zr has produced a i
who is personally known ✓or has produced a
as id Cation.
s
as i e tification.
r
STAMP 1
Signature of 1Jotary Public \\��11111i 1111111// Si tore of otary PublicSTAMP
{ \ WA ST // / \\111111111f11/
�Cl SSIp "
Print Name of Notary Public QGH 27Ai'• �� QX0. �� •'• tSSIONo,• 'i
P ,tNameo(NotaryPubllc V �GH27?o� ••
Z ;
#HH 106177
9�'•ya°odad 0•'�v a `per
�blic Unde p��� ��i9�i yAobltic Uns° c•-�� $E
Revised 11/16P2016 '// \\`\`
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