HomeMy WebLinkAboutcancellationPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
2300 VIRGINIA AVE
FORT PIERCE, FL 34982 MAY 0 7 2o20
(772) 462-1553 FAX 462-1578 sr. Lucie
County, perm.
CHANGE OF CONTRACTOR. SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change of Contractor is to besigned and notarized by the propertyhdmer,
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 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:
05/06/2020 Permit Number: 1411-0229
SiteAddress: 8023 PLANTATION LAKES DRIVE. PORT ST LUCIE, FL 34986
AMERIGAS PROPANE State License 02707 SLC License
Original GC, subcontractor or 6mer/builder
AMERIGAS PROPANE
New GC, subcontractor
License 02707 SLC License
Reason kr. Cancellation ,CUSTOMER WENT ELECTRIC - CAPPED OFF ALL GAS LINES
The undgrsigned does hereby agree to indemnify and hold harWnbeen
ficers, agents and employees from
costs, fees or damages arising from any and all claims of actioarise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit been erformed.
SIGNATURE OF OWNER (or ownedbuilder) Ar/rr)r'rIOR (ornew , as applicable)
PRINT NAMEl.�C.V
State of Florida, County of St Lucie County State of Norida, County of St Lucie County
The fallowing iasbument was acknowledged before the this
_day of 20_, by
is permnally latown to me
or who has produced as in.
05/06/2020
Signature of Notary Date
Revised 04/15/16
The following instrument was acknowledged before me this
_day of 20_ by
who is personally {mown to
me or who bas produced as ID.
05/06/2020
Signature of Notary Date