HomeMy WebLinkAboutRequest for Cancellation Te( (Y\ V1 4- `7
RECENED
PLANNING & DEVELOPMENT SERVICES
MAR 14 WILDING & ZONING DIVISION RECEIVED
n permitting aed2VIRGINIA AVE
St,Lucie C Ontv
RT PIERCE, FL 34982 OCT 16 2017
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
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.
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.
3� 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: 3' 1t-(- 19 Permit Number: 1707-0587
Site Address' 3871 Hwy Al Unit 801 North Hutchinson Island, FL 34949
The Home Depot/Raquel Swanner State License CGC1514813 SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation Customer decided to cancel contract prior to the start of any work
The undersigned does 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 aril as a result of this change of
contr ontractor or ca ]at' n of ermit.A permit ca •ncelled if work een etlormed.
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—77!e
SLG ATURE F ER( er/builder) SIGNATLI NTRACTOR(or new GC,as applicable)
PRINT N t1& _Y-_ PRIN1`NAME 24 L sax__!t aw"'
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
UP day of 00 201'1 ,by )i , 4> day of_ dX 20JM,byJP.�`.fit
mak^ who is personally known to me ?rtcy.✓ who is personally known to
or whohaproduced as ID. me or whohrod uced as ID.
Signature of Notary Date Signature of Notary Date
rr TIMOTHY P\.Ohdi`LLEY t
1JIY Col 7°gSSlON#GG 117135
Revised t 56.'
�= EXPPF ES.August 7,2021 ( KPa PU TIMOTHY R.d'MfiLLEY
Bonded Thru Notary Public UndMY CQhg 411SS10 #GG 117135
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EXPIRES:August 7,2021
Bonded Thru Rotary Public Underwr;iers r