HomeMy WebLinkAboutCancellation of Permit PLANNING &DEVELOPMENT SERVICES7r-
RECE VE� O
BUILDING & ZONING DIVISION
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2300 VIRGINIA AVE AUG 1120
FORT PIERCE FL 34982
� Permitting Departrr,e^•
(772) 462-1553 FAX 462-1578 St. Lucie Cni
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-
Co ctor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cance] tion 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: — q Permit Number: Q S' 3
Site Address:1=;&
State License SLC License
Original GC,subcontractor or owner/builder
State LicenseC C Q\ 2S�C License
New GC,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or ges rising from any and all claims of action for any reason,which may arise as a result of this change of
contractor/su 01 ontrac ancellation of permit.A permit can1 10 ancelled if work has b p rformed.
W V-V
SI A OF OWNER_ (or owner/builder) SIGN GENERAL-CONTRACTOR or new GC,as a cable)
PRI T NAME �Yp"/"U 1_7' 1y orto. PRINT NAME
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' torment was acknowledged before me this
2.3 day of A�:2:,201!91,by f�y day of 20�by Gt1AL.0
• T A S�A'Imlifl¢ who is personally known to me • /7"&I2SeD who is pers�nallly/mown to
or who has produced as 11). me or who has produced as ID..
Signature of N ry Date Signature of No Date 0//9115'
Revised 04/15/16 =0 Notary Public Stateof Florida ��`� Notary Public State of Florida
Shirley M Rearick 7, Shirley M Rearick
"1 a My Commission FF 9931130 w�P` fMY OS /g/2o2�993180
mor M1 Expires 06118/2020