HomeMy WebLinkAboutCancellation of permit PLANNING & DEVELOPMENTS
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE JAN 2 9 2020
' FORT PIERCE, FL 34982 permitting Department
(772) 462-1553 FAX 462-1578 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-
Contr ctor.
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: . C>2/UD-0- Permit Number: fl 7--
Site Address:
State License SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor +
Reason for Cancellation ' >I+_ c,,A
The undersigned does her b agree to indemnify and hold harmless St Lucie County,its offi s,age and employees from all
costs,fees or dama es sin from any and all claims of action for any reason,which ay ise a result of this change of
co a or/subcontr cto or ancellation of permit.A permit can LbDCgncell�d if or as ee per ormed.
�. .-
IGNA OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAMLCA)q Q ft ��C� 1 PRINT NAME2l. - �> �I�C47
State of Florida,Coulity ofSt?L et State of Florida,County of St.Lucie Co
The following instrument was acknowledged before me this Th f lowing' ent was ackmowledg be re me thi
, day o 20- Q by r �>�� day of 2�byq=
o is perrsLsonally known to me S who is personally known to
or who has produced •b1D� — me o has produce s
Signature of Nota Date Signature of Nota Date
B.HUMPNRE
Revised 04/15/1 -W AVD 3Q0817 AUDREYB•HUMPNR� r+
• fib''• MY COMMISSION62023 MY COMMISSION#CSG 300817
y Pubnc Undervn►tecs � �= EXPIRES:March 8 20ndotwruers 1{
��,,,1 nom■ i,,
':�•,Cf rM1O,:
B,-4w�tWl� �''f qF F�Oe:', Bw&d TW"ary Pu i.w �
Yl