HomeMy WebLinkAboutMI13XC060 CANCELLATION LETTERCourvTy �.
F L O R I D A
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRA TOR — 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 SIIBCONI. R CTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill ou� 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: 7/23/2019
Site Address' 3301 Orange Ave., Fort Pierce, FL 34947
Permit Number: SLC 1903-0158
ATS - Damian Quattlebaum State License SCC131152056 SLC License
Original GC, subcontractor or owner/builder
State License SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to jindemnify 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 re n, which may arise as a result of this change of
contractor/s contractor or Cance lanon of permit. A permit Cann ca celled if work has bee ormed.
N E E oro er/builder) /, PRSI 01 ATU GENERAL CON CTOR
4C (or new GC, as applicable)
PRINT NAME !/ tttL INT NAME Damian Quattlebaum
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this �yy,f4o�lt��wing ms�llm� ent was acknowledged before ore me this
;O day of �JLU_Y 202, by I Z = y of � 1_VA N . 20_Mbyj i) �
who is person Ily known to me Q.AQ r er_)CIur_A who is personally {crown to
o as m. me or who has p, odu d as ID.
' 1 Tsignatureo0o-tary �7 t� 7/23/2019
Signature of Notary Date Date
...WV, ,
Revised 04/151,090U. _ Notary Public S to of Florida ,),*v "Pe, Notary Public State of Florida
4 Heather T Garner = Hateigh Winsor
My Commission GG 315919 y My Commission GG 107346
Expires 0711912b23 9?or,vo� Expires 06/27/2021
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