HomeMy WebLinkAboutcancellation notice—�. .�.._._ PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
• 2300 VIRGINL4, AVE
a 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.
X CANCELLATION OF PERMIT
Cancellation of permit is to be signed and
cancellation of the permit.
Date: 06/09/2020
Site Address:
— The cancellation of a permit is acceptable only if no work has been done.
notarized by both the owner and qualifier of record. There is no fee for
Permit Number:
2005-0571
Unico Air Conditioning Co State License CAC1814920 SLC License
Original GC, subcontractor or owner/builder
New GC, subcontractor
Reason for Cancellation
License SLC License
Duplicate of permit 1707-0141 closed on 01/05/2018
The undersigned does hereby agree to indemnity and hold narmless st I
costs, fees or damages arising from any and all claims of action for any
contractor/subcontractor or cancellation of permit. A permit cannot be
John weber
SIGNATURE OF OWNER (or owner/builder) SIGNATt
PRINT NAME John Weber
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
9 dayof JUne 20 zo by John Weber
is personally known to me
ficers, agents and employees from all
e as it result of this change of
has iteen performed.
(or new GC, as applicable)
Oscar A
State of Florida. County of St. Lucie County
The following instrument was acknowledged before me this
day of ,2020 try OevAG6tld,
is personally known to
or o has produce � .as 11) me or who h p ed as D.
(� 06/09/2020 QO(, 06/09/2020
Signature of Nota Date Signature of Not Date
MW+fAM.AGUIRRE MARTA M. AGUIRRE
Revised 09/15/1E 'J; ri_' 191327 'g' �"`
�fi• M" _0MMISSION M GG MY COMMISSION B G, 191327
:+
_;XptRFS_ March 9, 20?2 '�- EXPIRES: March 9, 2022
puDlicUadatwdtets %"' ..... e' go�d Th, Notary public Understitem
- acnl;aTlrru Notary
FOFf �.