HomeMy WebLinkAboutcancellation noticePLANNING & 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-
ntr. ctor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
anc tion 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:
2/5/21
Site Address: X960 Godfrey Rd
Permit Number:
SLC-2005-0245
Total Home Roofing / Robert Donovan State License CCC1330489 SLC License
Original GC, subcontractor or owneribuilder
License SLC License
New GC, subcontractor
Reason for Cancellation Homeowner no longer wants re -roof. Not in contact with homeowner. No Work Performed.
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fror
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 en p ormed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL C OR (or new GC, as applicable)
PRINT NAME PRINT NAME Robb '�novan
State of Florida, County of St. Lucie County
The following Instrument was acknowledged before me this
_day of 20_ by
is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
State of Florida, County of St. Lucie County
eT wing m t was ackn led ed before me this
day of _, 20Ug by
RobertDonovan who is personally known to
me or who kas modumil _ as m.
of Notary
MY COMMISSION # GG g30S63
EXPIRES: March it, 2024 .19