HomeMy WebLinkAboutFence Permit Cancelation , 10.22.20PLANNING & 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 TJHE FOLLOWING:
CIIANGE 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 MOO fee for the Change of Contractor.
CRANGE 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-
Contr ctor.
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: o tPermit Number: S L
Q.. �n)
�0al
Site Addrs vLV,'/_3,4gS
le �r e-c ! r I C_S ke r State License SLC License
Original GC, subcontractor o er unlder
License SLC License
New GC, subcontractor
Reason for Cancellation O 'f 11 e
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.
SIGNATtRE OF OWNER (or ownedbailder) G SIGNATURE (KNERAL CONTRACTOR (ornew GC, as applicable)
PRINT NAMx' / erg SeC. �sS/.��� PRINT NAI41E
State of Fledda, County of St. Lucie Comity
The following insaument ww acknowledged before ma this
_day of_ 20_ by
Who is immorally knGm to me
or who bw produced w ID.
Sigmtumof Notary Date
Revised 04/15/16
State of Florida, County of St Lucie Comw
The following intro mi was acknowledged before me this
_day of— ___ 21 by
who is personatly known to
ice or who has produced as ID.
SignaMmafNotary Date