HomeMy WebLinkAboutCancellation formPLANNING & 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 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.
4005G— CANCELLATION OF PERNUT — 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: 12/1/2020
Site Address: 4005 Greenwood Dr
Permit Number: 20080307
Richie the Roofer State License CCCO58021 SLC License 2050 6
Original GC, subcontractor or owner/builder -Laj 6G
State License SLC License
New GC, subcontractor
Reason for Cancellation Homeowner ino longer wants to do the roof, selling the home. (k 5
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.
S OF OWNER (or ownerlbuil ed r) SIGNATURE GEN; EEiDCONTRACTOR (or new GC, as applicable)
INT NAM ' � ', PRINT NAME ,tchp►�d
State of Florida, County of St. Lucie County
The following instrument was acknowledged before we this
2 _ of , 20 by
7N44 AAb Q ._ who is personally known tome
or who has produced_., <C Z, as 11).
_. 211/2020
Signature RICH1 NEWLA D
MY Cor, WISSlahl a GGaSOW7
Revised 4 � s EXPIRES AP6103, 2021
State of Florida, County of St, Lucie County
The following in trum nt was acknowledged before me this
—day of.202A , by
is personall known to
me or who has produced as ID.
1
Notary o is state of Florida
Signature of Notary Melissa Cole
i My Commission GG 253806
�Q FXpires 0911412022
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