HomeMy WebLinkAboutcancellation notciePLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 4624553 FAX 4624578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLO WING:
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
contactor 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-
C ntr ctor.
CANCELLATION OF PERNHT — The cancellation of a permit is acceptable only if no work has been done.
nc llation 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.
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Date: , Permit Number: (_ } 1 U 4'u B
Site Address: a 2./S ZB 1 4 !' f e 6
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ft ue-�_ [..�l'2lt �... � rate License 6 4L License
ri2inal GC, subcontractor or owner/builder
License SLC License
New GC,subcontactor
Reason for CancellationP'�
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from 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 k eenperformed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GE ONTRACTOR (or new GC, as applicable)
PRINT NAME PRINTNAME :)& iii`-s-6
ty
State of Florida, County of St. Lucie County
The following instmment was acknowledged hefore me this
day of 20J by
is personally known to are
or who has produced as ID.
Signature of Notary Dale
Revised 04/15/16
State of Florida, County of St. Lucie Coun
The Bowing in ent was acknowledged hefore me t urs' ay of , 2by t,,,2 a�.,ict,•7 �-
J who'tsperrsonally known o
me or who has produced `- as ID.
Signatur No aryN� 1 ZJ
R
,.�'�r °�a^.,_ COURTNEYE BEGAN
i`a®Notary Public -State of florida
Commission p HH 028294
`:or ryE, My Comm. Expires Sep 19, 2024
Bonded through National Notary Assn.