HomeMy WebLinkAboutCancellation of Permit _ PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
COUNTY 2300 VIRGINIA AVE
- - - FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
Im
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF TIE 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.
-1-0 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: 03/16/2020 Permit Number: 1910-0632
Site Address: 7401 Arthurs road
Construction Management of Florida,Inc. State License GCG 057311' SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation Homeowner decided not to change out door
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 forany re w ' may arisk as a result of this change of
contractor/subcontractor or cancellation of permit.A permit cannot b ca Wor ha been performed.
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�-- 1nrSIGNAor owner/bui Ter) SIGNATURE GE CONTRACTOR�new GC,as applicable)
PRINT Champman PRINT NAME Ignacio f Lizama
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 instrument was acknowledged before me this
16 day of March 20by Margaret 16 day of March 20 20 by Ign---r
Chapman ___wJLd is personally kno to me Lizama who is p oval to
or h as produ as ID. mer ho has produced/ as ID.
03/16/2020 �� r ��7(� 03/16/2020
Signature of Notary Date Signature of Notary Date
Revised 04/15/16RM
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MY COMMISSION#GG923892
3 %;0F ,f EXPIRES.October 17,2023