HomeMy WebLinkAboutMisc Letters/cancellation of permit 01-06-21 ; 10:45 ;From; To:94621578 # 1/ 1
PLANNING &DEVELOPMENT SE
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2300 VIRGMA AVE
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(772) 462-1553 FAX 462�-1578
Permitting Department
St. Lucie C unty, FL
CHANGE OF CONTRACTOR,SUBCONTRACTOR OR CANCEL
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PLEASE SELECT ONE OF 37E FOL OWTN(i:
CHANCE OF CONTRACTOR—Change of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current
-r' aorttractoiuormtitina nd si�na"fuxe:-"E#'xiew m mpe ^Amt.,
also.be..completed-with-new---
Notce 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 roust fill out a Subcontractor Agreement Form,There is a$50.00 fee for the Change of Sub-
Contractor.
_CANCELLATION OF PERIWT—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: 9 1 Ci 10 RIO Permit Number:
Site Address: �--� '-'� i R e S. J e g L sJ r ee
Q J J e-g, State License SLC License �.
Original GC,subcontractor or owmer/builder
State License _._ SLC License __....
New GC,subcontractor
Reason for Cancellation A Pc T-� 6 0-R OF Morow p•f A 5j,
e 4 Q $4F}P4 &.ojee-T
— T'Ixe,mdersigned-does-lieMby agree to-indemnify and h61d ha less`St)✓uric County;its officers,agents and employces'f6rom Al
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.
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SIGNATU E OF OWNER or oWncr/builde�r)) r� SIGNA'I`1JRE GENERAL CONTRACTOR(ornew GC,as applicable)
ME PRINT NA —1_C_C114 C') J C' 1 1,iC'_K P- PR1NT NAME i
State ofblorida,County of&Lueic County State of Florida,County of st Lucic County
;
The following instrument was acknowledged before me this The following instrument was aeknowledgod before me this i
day of�,20ab ,by cN�Ot�� day of .20,_,.,by !.
S;
w o is Pe rsOnully known to mo who is pmonally known to
VtPt
Cd I n as ID. me or who has producod� as ID.
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Signature of Not,'
ry �,�r.��.rM++e+ Signature of Notary pate
0689A A.MCCAIN
C0Mm1Ww#GG24t428
Rev�,sed 04/15/ E*IM3 Nomber 20,2022 g 7619
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