HomeMy WebLinkAboutCancellation of PermitPLANNING & 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.
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: 2/1 /2021
Site Address: 2117 Nobles Blvd., Jensen Beach, FL 34957
Corsair Property Solutions Inc.
Original GC, subcontractor or owner/builder
NA
New GC, subcontractor
Reason for Cancellation Owner no longer wants the job
Permit Number: 2101-0553
License CRC1331855 SLC License 32159
License SLC License
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 cancelled if work has been_pedermed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURES GENERAL, CONTRACTOR (ornew GC, as applicable)
PRINT NAME PRINTNA M Russell B Williston
State of Florida, County of St Lucie County
The following insmiment was acknowledged before me this
day of . 20_ by
who is personally knowo to me
or who has produced as In.
2/1/2021
Signature of Notary Date
Revised 04/15/16
State of Florida, County of St. Lucie County
The following instmmeat was aeknowled ed before me this
.I - day of .�2.10. , 202t, by 1 iCC 11
o W l I I 1 sSio' who is p�^s ya,lly� �Down to
or who has preduce AV-WL1as'o.` 1D110
�`% 2/1120212/112021
Signature of No Date
Mp' ty CASSAN�RA M-VOLAGE
i; ; Notary Public • State of Florida
i�f,Aj Commission # GG 923210
„pr KI My Comm. Expires Oct 16, 2023
Bonded through National Notary Assn,