HomeMy WebLinkAboutCancellation of Permit 2017.05.24 02:37 PM CORAD INC 5614392184 PAGE. 1/ 1
PLANNING & DEVELOPMENT SERVICES.
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)4621553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELEQT QNE QE TldEl_I+OLLU1ydINCi:
CHANGE OF CONTRACTOR—Change of Contractor is to be signed acid 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 inforination 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.
CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be signed by the general contractor only,.
The new subcontractor must full out a Subcontractor Agreement Form which is signed by both the contractor and
su ontractor.There is a$50.00 fee for the Change of Sub-Contractor.
CANCELLATJON 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
eanceilation of the permit, r
Date: _ 5~a 7 permit Number:_&Ga —ao,
Site Address: 7 t l C�N�. CIPIe�&e
State License SLC.License
Original 0C,-subcontractor or owner/builder
State License SLC License
Now GC,subcontractor or owner/builder
Reason for Cancellation
The undersigned does hereby agree to indemnity Arid hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from tiny and all claims of action far any reason,which may arise as a result of this change of
contractor/subcontractor or cancellation of permit.A permit cannot be anacllcd if work has been performed.
STGNATURE OF OWNER(or ownerAitid(ler) 51c,N U118 GC+NF..RA ONTRACT t(ora , 1 icublc) D Q�
PRINT NAME— PR T NAME
Slntc of Florida,county of St.Lucio County Stato of Florida,County of St.Luclu County
'rhe fbllowing insu•utnant wus ucknuwledged before rao this The ful(owing ii Ht merit was acknowledgul before me th'
day of_-__. ,20_,by -� ny of 20L—L by Cmc?
who is personally known to me n 13personally know to
or who has produced ns R), nt or W
Signnture or Notary Date '� f t4�'tqqMM188 e
C-XPIRFS FeG �tY��,X019
407 8 U'AM1 Flwtdrlddt! 8ervbo,tdm
Revised 05/19/2017
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