HomeMy WebLinkAboutVoid Permit Request �!Lj % -4 WXG 8:1 'Ev �.Q '11�IENK`SER'VYG"ES�
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IIICEME CO1 TI CTO JBCo 'lr Ac�roi . CANQELrAOFtE MT,
;PLEi4:SE'SETW ONE-off.THSFo ��
C C� O 'CONTRACTOR .change o Coniraetor is to be signed andaotar d by owner;;
e +contracts of record far the innren€per tr t �ne�v{ e�tnt Pllcxhon xiipust'aha be co" wv dew°
contractor;mfom>ationand;s gnature new I�Totice of Commencemed mush be Md au the near eonfractot'si nainie
z�Qrt,lobi watue��g�ter S$25�00 (�7,�SQ�F a��il(3 Gage-o�t� �. ozde�.ots��;most ise ksuh�+ prior toy;
commencuY aiir dark:Tbete is a50:OQrfe$fo -tliei Change oGoacar., Y
CH ,1+OE DR SUBC�NTRACT �2, Subcontractor changed to be eomp�eted bygenerarconiractor::
The newsubcophad br,must. od, Sn ..Tte cas a S50.00.fal le:#bie Chan a of u -
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ATION:OE PERNII P T ie--cancellation-of-a:pemy W.acceSUN-..orily I -M-0rk•hasbee lone;
Cgncellation.t►€peanit is;to be signed and> of razed by', otl ttie own ed qualrfier of record Tli is no feed.fur-
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caaceltafionaf the�permit:a
;nage. seter s;2o2g t Perm> ]1Tmb _
a 1:902-0592
. S`it�AddtC33's i.���_.;�.�+�a_F'xs�-�=° ,- �°�"•-��' ':��'.. ��`l�1�{
"snticonaactoior ownerlhuilder.
New GC,subcotfracto>-
R:�son for cstteell�on1�lark�ne�er per�o�rrle��.duey to#�u fixco_s�
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:The undersigned does he�rel<yagreeto,-pndem�pa�ty andholdharnaless S�Lticde,Couniy,ifs officers;agentsand�loy�&om`all?`
costs;fees or^damages artsmg,from any°aud aIl c'Taams'ofaction for an3r zeason;w�uch may ansa as a result afthis cfiangeof�
�., — ll� work bas,6eEn rfijrmeit,
:conhactor,(suTcozitiacfor,or c�icellation ofpernutr A pex'w�cafnnot be cane. __�..._._ ;pe_ -
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(oroarnerw7der). .___ SIGNATCTRfi,GE�ERA�,COrIfRAGTOR(oiriiwvCC;;a�s�tIplite)
.....I ERIN�I�TAME%
�tSte.of-Elands,Gt�untyof.".�Lncie.Gountyi Made:ofElondanomxLumWGo
"Chefollo�nng�as�uaeut�vasa�c�rledgad�hefoYe m��? 'fhefollowmg ms�ument was actarnwledged before m��tus .
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SSgnatureo€Nataiy ,Date, Sigoatareo£Nai� Dai
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