HomeMy WebLinkAboutCancellation of Permit . f
AAN11 0&DE`UEL.OPME IT StRVICES"
ri FORT PIERCE;TL 34982
- _ --_�-=- �T 214
62.,1553 FAX,4 '2,
''2..I5Z8; MAY 14 2020`
ST. Lucie County,, Permitting
CHANGE DV,CONTRACTOP SIJBC0NTRACTOIt.:dR,CANCELLATIOIY.O1 P
PL;EASE'SEMMOM.OF THETOT F aWINGs
y_ CHANGE O CO1TItACfiOR Change bf,Contractor Is to be signed anx►otarized byte "pe-y
and the new contractor of record for the current pe- t A new permiit applicatzan.must also be+coinplefed vYIQi uevtn .
contractor lnfazmatlonE;an�d signature A.new'Notfce.of Connme.`riceuieut mus"tete.,:fled!in the new contracfor's:l,'name
for Job°values,:greater than, $2,501) '($"l,�Ut zf AIC"Change-out)', A:recorded !;gp must be submitted prior Cd
y . .
conlmencuig aIIar•work:There;s a$SO OQ fee for,the;Change of Contractor:
CHrrNGE OF`S BCO,TRACTOR=,Subcontractor changes aze to be campletedby the,grrnezal`:cgntra ct4r:,
The�new subcontraotor must
--wt it Subeontracfor tYgroemeat Form.There'7s a$5Q 00 fee dor Q Change of so—
Coirtracfor*; ..
*---U CANCELLATION OF PERM, T-he cancellation oFf"ipermii iszacceptable only°, no work hw-'been clone;
Cancellation>of'permik is 7o be.sigaed`an8,notanzed.. y both be.owner and;cLuallfer o£record There�s no 14ee,for
.cancellation,ofthepermat• .
Permit Numbet•y :loos ogs{
Si�Addx<ess zo tu�mrrEt�antF�v r�oFtTH, - ,
yuYAit+1E DE1lELOP51tEAi1 :_ State License: SL.CI;icense
�UngmaI°GC,�subcontiactor:or'awner/bur�der - '
StatezI icense
New'GP-pit contractor-
;Reason fpr Cancellation. 'SEINES?LlNE;!?EfECTED IN MtQ LE`Q, 0 -1, NG lii U 45UILQABLE
here} l
The Inrderstgned does y agree to tndemnfy and hold harmless St Lucid County,its officers;agents`and employees from all
costs,fees:;or damages arising from anx andsaIl claiius of action.for any reasgtix-which may arise as a result of;;thls charigeh4f"
.contractor/subcontractor., , ",of, ermit ApermiEcannotbecaneeIleclifivork_hasbeen;perorme ,
:SIGNATURE QF..OWNER(ornivaej/6itlier� " ' SIGNS'C[JAS"GFa`�iEkA�GO15TRl�CTOFt(ornegrGC,�asagpf�cabtef;
PRINT NAME MATTHM,,L'YLE V4 yYN PRINTNAME
State of Fio&*Copnt}r of St,I ucie'_QDunry< State of Florida1;County'of St I ucie Gouiit-P
'The fo owus�mstium�at was ac�atowledgec}befocc me flus, The,followmg tnstrumentwas actmowledged before ma tlxis '
`da of _,20 by wm+Ewrn Exra day of _„by
_ who is person gy`k owf to mei
.. _ _ o own-.to
.^ wh is�ersonaIlylm
o wbo had produced' as ID„ M mgnr_g R has produced _ <
!f
Sigmturc"of No .y Date is� $ j' S�gnatnreofhofary
.. ,. Dace ;
..n.rlf
Megksed
�,�'��`"Y�,� .� DORDTtiYANNl3A5Kl(V ��, _
'.01V4,15/16 t " ,3 N11'CQMMISSiDN#GG:030145`
of EXPIRES tkt6Ger2=2020
. �y;�„t7 9onded+ihtuNotaryPuhGcUr�lenmtecsr ' .