HomeMy WebLinkAboutCANCELLATION OF PERMIT"Viay 04 18.01:442p South Orange Friendly
05/04/2018 09:53 77257ISS78
973-762-3716 0.2
CLzSTOM AIR =AGE 01
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA. AVE
FORT PIERCE, FL 34982
(772) 4621533 FAX 462-15?8
THE F0.1.I (Y%?NQ;
CMA.NC;E OF CONTRACTOR—Change ofConttac-oor is to be signed and twtarized by the property owner.
anti the new contractor of record for the current permit. A new pewit application must also Ise completed with new
eontractos information and signature. A new Notice of Commencement tnus;t be filed in the new contractor's t:arrc
For job vai,sec greater than :12_,500 ($7.500 if A.'C Change -out). A recorded copy mus, be submitted prior to
w-nrrn:.—,cing any work. There is a SM.0 t fee for the Change of Con"Ctor.
C4IANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the gcnerz.l contractor.
The new subcontractor must ,rill out a Subcontractor Agreement Form. There is a $50.00 fee for the Chsnge of Sub -
'V CANCELLATION OF PERMIT— The cancellation of a permit is acceptable only ifno work has beer done.
Cancellation o,' permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
LAncellatirm orthe permit
Date: ; _ )? Permit Minther: t YO - 0k, � ?-
ez
Sire Address._ �l°fI �atuM', brink L-ir
t (k ,r ., C7 M s 1 r%C- State License t CD5 t 8 f u a 1 7
�,..tza a �, ��uS.� SLC Liccn_c �
Originai OC, �ubcora{, or or owneribuilder
State Li; ense�_SLC License
New GC, suh*3ntractur
i
R ueriorC2nreltatipr, t,kq-ro4rcr Wants anot�r Come
Thr or4ercigiied dory hereby agree to indemnify and hold harmlecc St Lucie County, its cfYccrst agen,c and employees fMrr. ail
casts- fees m damages arising from any and all eiairns of action for any reason, which may arise as a result of rhlF cbur+gc of
cpntracinr(subo mtrartnr or conL-42ilaatiOn of permit. A perms cannot be cancelled ifpmrk has l formed.
SIGKATURF,S1 NAr .Cr NERALCONMACTOR(runew GC asaptolkaW
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NotelY PubNc
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-- My Cojirnlssion Expires hiov. 9, 2020
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_F I 4.D.# 50027474
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* * MY COMMISSION # GG 05250
EXPIRES: April 4, 2021
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