HomeMy WebLinkAboutMisc Letters/ void Permit J y y PLANNING & DEVELOPMENT SERVICES RECEIVED
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE NOV 2 3 2020
FORT PIERCE, FL 34982 Permitting Department
(772) 462-1553 FAX 462-1578 St. Lucie County
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. Y
Date: /.41MI a Permit Number:
Site Addres
s: ,g /
11 505-e. E c;�t`o c-Cva)) Wr rr .1 er,State License ECO PX SLC License e2f79f*�
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor y
Reason for Cancellation Jai rj`�1/¢P S�Ct/'t�0.. iVl7�r���jC(a►GoT O'iieG'f'�On
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 cance 'fas been performed.
SIGNATURE OF OWNER(or owner/builder) Sfd#AtU1&GENER••��A��L CTOR(or new GC,
,aslapplicable)
PRINT NAME PRINT NAME I M!/U • a V`l'r >°cl
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 aclnowledg be or me this
day of 20_,by �day of lTU 2oJ� b y �
who is personally known to me who is personalb known
or who has produced as ID. me or N=ced as ID.
Signature of Notary Date Signature of Notary Date
Revised 04/15/16 i ,'ii.�+?!''•, AUDREYh3.HUMPHREY
- . }- MY COMMISSION#GG 300817
EXPIRES:March 6,2023 I
Bonded 7hru Notary Pubiic UndenvritersJ
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