HomeMy WebLinkAboutUntitled From:Mike Heissenberg Fax:(772)871-0990 To: Fax: (772)462-1578 Page 2 of 2 10118/2017 9:19 AM
' 7 PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION 1�
0 2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUPCONTRACTOR QRCANCELLATION OF PERMT
PLEASE SELECT ONE OF THE.FOLLOWN0,
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 550.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR--Subcontractor changes are to be completed by the general contractor.
The new subcontractor must till out a Subcontractor Agreement Form. There is a$50.00 fee for the Change of Sub-
Contractor.
X CANCELLATION OF PERMIT-•The cancellation of a permit is acceptable only if no work has been done,
Cancellation of pen-nit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 10/16/2017 Permit Number: 170s-0417
Site Address: X
Expert Shutters;Michael Heissenberg State License SLC License 16572
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation The house is a mobile home,this permit should not have been applied for or issued.
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
casts,fees or damages 'sing from an,'arid all claims of action fbr any reason,which may arise as a resul of'this change of
contractor/s bco.`tr.ctor ca cellat' n of permit.A permit cannot b'M-N,c eller!i va t,l en p ff rmed.
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SIGNATURE OF OW ;R or owner uilije) SIGNA'T'URE GE1vi.RAL C.C)NTRACTOR 1,ttr ne:GC,us applicable)
PRINT NAM ���r�c� jf�t ����'� PRINTNAM; E
State.ol'Ftorida,County orst.Lucie County Stake uFFlorida,County of St,Lucie County
TFhe lbllotiNing instrument was acknowledged before me this The following instrument was acknowledged beforc me this
,ce day ofL .L 201a.,l 41WdCLJL2.-C I —".Q—day of_QL4 )Ql_':f 20�1,by .!.I
's is r yyho is.t*er.�s m llv knot4nknot4n to me 4 y 1 t al t who isersanall knm nva[ [o
ur tto has prodt[Ced as lt). me 7r who has produced as iD.
LA r,
SiBnaturo[nr 'otarg Datcignahrre of otary Date
Revised 04/15/3.6 p Haleigh Short Holeigh Short
t� d NOTARY PUBLiCa�X' s
NOTARY PUBLIC
STATE OF FLORIDA STATE OF FLORIDA
Comm#G+'",�r148342 "Comm#GG148342
Expires 5125/2021 Expires 6126/2021