HomeMy WebLinkAbout2016 canceled permit 1606-0367PLANNING & 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.
-INNNF 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: 7/17/20 Permit Number: 1606-0367
Site Address: 4949 N HIGHWAY A1A 132, FORT PIERCE, FL 34949
ARS RESCUE ROOTER State License CMC1249753 SLC License _
Original GC, subcontractor or owner/builder
State License SLC License
New GC, subcontractor
Reason for Cancellation CUSTOMER CANCELLED INSTALL
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 for any reason, which may arise as a result of this change of
contractor,'subcontractor or, cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL NTRACTOR (or new GC, as applicable)
PR1N-1 NAME ALICIA SLATER
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
17 day of JULY 20 210 , by
ALICIA SLATER who is personally known to me
oT roduced DRIVER LICENSE as ID,
1117/20
Signature of Nota Date
FState
A CHATEAUNEUF
Revised 04/15/36lorida-Notary Public
ssion # GG 340178
ion Expires May 30, 2023
PRINT NAME Dennis Zacek
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
It day of — , 2020 , by
DENNIS ZACEK
me produc
Signature of Notary
who is personally known to
IICENS& ID.
7117/20
Date
MELISSA CHATEAUNEUF
State of Florida - Notary public
Commission # GG 34o178
My Commission Expires May 30. 2023