HomeMy WebLinkAbout15011 Okeechobee Rd - Permit Cancellation Request Form 10-19-2020PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
BM 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 — 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: 10/19/2020 Permit Number: 2001-0132
Site Address: 15011 OKEECHOBEE RD
JAK, Inc. dba Applebee Electric State License EC #0002956 SLC License 19055
Original GC, subcontractor or owner/builder
N/A
New GC, subcontractor
State License
Reason for Cancellation CUSTOMER DECIDED TO SELL PROPERTY
SLC License
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 apy and all claims of action for any reason, which may arise as a result of this change of
c ra r/subcon' ac or canu 11 ion of permit. A permit cannot be cancelled if work has been performed.
r
§IGJohn M. Applebee NATU OF OWNER (r wner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
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P NAME pp PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
19th day of October 20 20 by
John M. Applebee who is personally known to me
or who has produce as 1D.
10/19/2020
Signature of Notary Date
nevi QV'AMELISSA PARRAMORE
Notary Public • State of Florida
• `� • _ Commission 9 GG 126946
wee: My Comm. Expires Jul 23, 2021
4�or F�
Bonded through National Notary Assn,
State of Florida, County of St. Lucie County
following instrument was acknowledged before me this
_day of ' r 20 20 , by
who is personally known to
me or who has produced as ID.
Signature of Notary Date