HomeMy WebLinkAboutCancellationPLANNING & DEVELOPMENT SER
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
RECEIVFD
AUG 28 3j9
ST. Lucie County, permitting
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.
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: D.S_ ! "\ Permit Number:
Site Address: �_ �?� S C 4_ IL� L% VA
z �fr to License SLC License
Original GC, subcontractor or owner/b ilder
State License SLC License
New GC, subcontractor
Reason for Cancellation blkY+•d \q\ae9 - OG-61
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fee r arpages arising from y and a ; laims of action for any reason, which may arise as a result of this change of
contrac or ntractor or can l tiof.. t. A permit cannot be cancelled if work has been performed.
S GN OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME'_ �_Oa*le
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
a. dayof•4yVj ,20%-%byq�lfd►
\-\ a -
b e , A �A) who is personally known to me
"o has produced F 4- P 'I -as D.
Signature
DEANNAMARIE GIVENS
M�Y.1 �COMMISSION # GG 022023
15 ,(pIRES: December 16, 2020
Bonded Thru Notary Public Underwriters
PRINTNAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of . 20_, by
is personally known to
me or who has produced - as ID.
Signature of Notary Date