HomeMy WebLinkAboutMisc Letters/ cancellation of permit PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
® 2300 VIRGINIA AVE
o
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.
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: 1 (� ^ ` d o Permit Number:
Site Address: �� �C� �—�
Ue �C�lry State License SLC License
Original GC,subcontractor o er/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation Lay-, O�V~ �>� Y�0►'���-f y \� ���`r�
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
co actor/su contract cancellation of permit.A permit cannot be cancelled if work has been performed.
IGN /O� (�(or owne f ^illdder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME l9�vT K l y �(,i6 fj�CL PRINTNAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
day.of 20_by day of _20_,by
who is personally known to me who is personally known to
or who has produced as ID. me or who has produced as ID.
Signature of Notary Date Signature of Notary Date
56r V
Revised 04/15/16 /� W
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FLORIDA INDIVIDUAL ACKNOWLEDGMENT
F.S. 117.05(13)— Effective January 1, 2020
State of Florida
County of a[c ��{,���i
The foregoing instrument was acknowledged before
me by means of
[Physical Presence,
/ \ —OR—
❑Online Notarization,, ��
this�+b lo Uday of i3Ly- , 2,Uw, by
Date Month Year
GcoFFe-e>4 LPeua_:�_,
Name of Person Acknowledging
Signature of Notary Public—State of Florida
f-,,M ss A_f\Z eA
Name of Notary Typed, Printed or Stamped
.6 A4 i4%.; CASSANDRA HANSEN
Notary Public.State of Florida ❑Personally known
Commission#GG 257552
My Comm.Expires Sep 11,tozz Produced Identification
Type of Identification Produced:
Place Notary Seal Stamp Above 1. l>7Z I n-j 5 —930 ----
OPTIONAL
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: PE—or—M IT
Document Date: `" ZU Z v _Number of Pages:
Signer(s)Other Than Named Above:
(02019 National Notary Association
M1304-11 (01/20)