HomeMy WebLinkAboutPermit cancellation Brown SLC 2010-0692.pdfwoom
COUNTY
F
L
O R I
D A
PLANNING & 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.
X 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: February 18, 2021
Site Address: 152 Ca lie De Lagos, Fort Pierce, FL
Original GC, subcontractor or owner/builder
Permit Number: SLC 2010-0692
License SLC License
State License SLC License
New GC, subcontractor
Reason for Cancellation
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 cca ellation of permit. A permit cannot be cancelled if worA has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRAC (or new GC, as applicable)
PRINT NAME P PRINT NAME 1 L
State of Florida, County of St. Lucie County
State of Florida, County of St. Lucie County
Thefollowingins ent was acknowledged before me this T1he/°Mowing Tistmnent was acknowledged before me this
11 1? _day of L 201, by 11 day of / o 20a, by
who is personally known to me 1 1 7 l� who is personally_ [opt to
o who has produce as ID. e r who has pro ced as ID.
February 18, 2021 February 18, 2021
Signature of Not Date Signature of N t ry Date EY - —
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