HomeMy WebLinkAboutCancellation of permit r V G' q0 2 ®RP-
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PLANNING & DEVELOPMENT SERVICES
- = BUILDING & ZONING DIVISION
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2300 VIRGINIA AVE
FORT PIERCE, FL 34982 j
(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.
""P13 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: 7/18/19 Permit Number: 1905-0278
Site Address: 4914 PALEO PINE CIRCLE, FORT PIERCE,FL 34951
ROBERTO SANCHEZ State License CGC1522717 SLC License 15487
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation THE CUSTOMER DECIDED TO CANCEL BEFORE 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 arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled t' w k has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL'LCONT�R,AtCCT (01"new new GC,as
applicable)
PRINT NAME PRINT NAM _�
EI �J`UU c Sc�!t�W�'Z
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this
ldo og-6�enentt was kledg re me this
v� '� � bo c� fj
day of 120_,by ��
who is personally known to me who rsonall wn to
or who has produced as ID. me or 1 pro as ID.
7/18/19 7/ 8/19
Signature of Notary Date S re otary Date
Richie Roberts
Revised 04/15/16 NOTARY PUBLIC
STATE OF FLORIDA
Comm*FF959.W
;1 m Expires 6/4/2020