HomeMy WebLinkAboutCancellation of PermitPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE, FL 34982 MAR 0 4 2020
(772) 462-1553 FAX 462-1578
ST. Lucie County, permitting
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OFPERNIT
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 }ss �bcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
ContpFor.
L' 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: 2, N �-ZD
Site Address:67,12 a F4S�Woj C6,
Original GC, subcontractor or owner/builder
Permit Number: %[XQ-L — 02/(9
License SLC License
State License SLC License
New GC, subcontractor YU %LGI /` 1 /
Reason for Cancellation y / b T/ it) aw A cawv AV . Ol-bJll6 V7 I P
The undersigned does hereby agree to indemnify and hold hanfdess St Lucie County, its officers, agents and employees from all
costs, fees or damage ising from any and all claims of action for any reason, which may arise as a result of this change of
contracfarf�icontraq�r or cancellation of permit. A permit cannot be cancelled if work has been performed.
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State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day olm44.2010 byRJ66s,11.
has omduced F L d L
is personally (mown to me
1i
SIGNATURE GENERAL. CONTRACTOR (or new GC, as applicable)
PRINTNANIE
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
_day of 20,_, by
is personalty known to
me or who has produced as ID.
OEANNA g1E GNEN4 Signature of Notary Date
MY COMfdISS10�V it GG 022023
EXPIRES: 00cemberi6.2020 +
'nded ltw Notary Public Underwrites 1r,;
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