HomeMy WebLinkAboutCancellation of Permit PLANNING&DEVELOPMENT SE ' VICE'S fL.I `6A y
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BUILDING & ZONING DIVISION
COUNTY 2300 VIRGINIA AVE
L-, fLoiRitP _, c-=.z— SEP 202018
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 Permitting Dep rt;hent
St. Lucie County, FL
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$50.00 fee for the Change of Sub-
C t ctor.
CANCELLATION OF PERMIT—The cancellation of a permit is:acceptableonly if no work has been done.
Cancellation of permit is to be signed and notarized by both the owner andqualifier of record. There is no fee for
cancellation of the permit. 1— ./ 69 .
Date: - 1�"� Permit Number: A 7 0833
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Site Address: gT 4J M 111 CA,
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State Licens LC License q11
44/4
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation C"tion42-(2-
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/subcontractor or cancellation of permit.A permit cannot 14
c. celle•.if work has b`' performed.
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SIGNATURE OF OWNER(or owner/builder) SIG '1•L91.7i G (• CONTRAC OR . i Si P`,as applicably 11
9 PRINT NAME PRINT NAME efhQ-n, 6. rd-zip,4,4„...r,
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this Thg fIllowing instrum t was acknowledged before. e this
day of ,20 ,by 7 day of j 20y /=� �
who is personally known to me A fi.. -s.ersonally known t.
or who has produced as ID. •-et21:!.
• . o l uced as ID.
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Signature Notary Date ture of Notary D
a)
Revised 04/15/16 Y.,_1, r
UBERIYA.KING
00.,'3 MY COMM$SSIQN ttGG 094838
t. -•'''.:- :'-`i EXPIRES:May 4,2021
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