HomeMy WebLinkAboutwexford way cancelCOUNTY
p R i D n
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34"2
(772) 462-1553 FAX 462-1579
PLFASE.5fiLFCT ONE OF THE FOt LOWLNG•
CHANGE OF CONTRACTOR —Change of Contractor is to be signed and rrotarizod by the property owns,
and the new contractor of record for the current permit. A new permit application must also be completed with new
conU=W information and signature. A new Notice of Commencement must be filed in the new contractw's name
for job values greater than $2,500 (S7,500 if A/C Change -out). A recorded copy must be submitted prior to
commencing any work. There h a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the gent fal contract
or -
The new subcontractor must fill out a Subcontractor Agreement Form There is a SS0.00 fee for the CCkMW
Sub -
Contractor.
_CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been dam
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. There is 00 fee for
emaedlation of the pera4it.
Date: ;a')6A
Permit Number: ?, 1 o i - 0
Site Addren:
6LACit 5AW State License SLC License
Ori&W GC, subcontractor or owner/budder
State License SLC License
New GC. subcontractor
R,aason for Cantxllatioa t `l � r
The un&wigned does hereby agree w indemnify and bold harmless St Lucie County. its officers, agents and =Vloym from all
oostsnaria many and sll claims of action fot an awn, which may arise as a result of this change of
c�a ntrac ellation permit. A permit caaoo ca celled if work bas been perfermtd.
SI�IA 1I1AS O (or S1tiNA CONTRACTOR tar x.a^GC. tt apQtio—� tbk?
PRINT N11lttt,� PAAti �1VT�i`- 1JZiLl4Gl�
Sho of flwds. CouaY of SL Lk'cia Canty Stste of Florida. County of St. LAXie Cougty
was �olmew k to a The fwowmg d wn acl� mowledV_dd �befom we this
day
�r _day of bY1_I�.LL_ A DD 4G'C .
of 1 ���
or who ho
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spoke &W Dow
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or Cash. tav'ntilt i, ma
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skmdm of tr.bwy Daft
Nicole Ottado
NOTARY PUBLIC
STATE OF FLORIDA
Comm# GG245418
Expires 12/1/2022