HomeMy WebLinkAboutCancellation of permit form0( ,
PLANNING & DEVELOPMENT SERVICES
k 'U C1 t.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 complded with new
contractor information and signature. A new Notice of Commencement must be filed in fe new contrador JJ 4 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.
u �' CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contracwr.
'`�" The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Cltmp of $ab-
Con actor.
,{ CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no wort has beams done.
Cancellation of permit Is to be signed and notarized by both the owner and qualifier of record. There its no fee for
cancellation of the permit:
} Date: Permit Number: Ot 1 k- Jni
Site Address:
a state License SLC Umw a 35
OriginatGC, subcontractor or ownernmddcr
g>c , NeGC/''� ,
, subcontractor}Gy ,1r
Reason for'Cancellationsi
The undersigned does'herebyagree indemd y end hold harmless St Lucie County, its officers, agents andfiamafl
c fees or arising from any and alk dlii rig of aehod for
oats,, damages whiel} miay arise as a result of taus of
1 y�'f contractor/ or cancellation'of ptrti�G A pecmfit cannot eilet
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SIGNAW" OF OwN&R (or owner/ mW;r) r SIGNA11 RE C'D )R (aacw cr,
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