HomeMy WebLinkAboutVoid PermitPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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 PER HT — 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: 6/4/2020
Site Address: 66 LAS CASITAS
FLORIDA STATE ELECTRIC
Original GC, subcontractor or owner/builder
New GC, subcontractor
Permit Number: 2004-0444
License SLC License 27267
License SLC License
Reason for Cancellation INCORRECT ADDRESS PUT ON PERMIT
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees or damages arisi ny and all claims of action for any reason, wich may . e as a r this change of
contra /subc ct o c 1 ti n of permit. A permit cannot Mn
d if as �e rm d.
SIG OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME ALAN WALTON PRINT NAME ALAN WALTON
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
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who is personally known to mew�to is personally known to
or who has produced as ID. / e or who asp uced as ID.
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Signature of 14"ry Date Signature If Notary Date
DOROTHYANN BRAIN ••`My; DOROTHYANN BASKIN
Revised 09/15/1 f• = MY COM030145 c,�• MY COMMISSION#GG 030145
EXPIRES: October 2, 2020 ,: ,gip EXPIRES: October 2, 2020
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