HomeMy WebLinkAboutPERMIT1909-0354 PERMIT CANCEL REQUESTCOUNTY
F LORI DA-46
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.
—8= CANCELLATION OF PERMT — 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: 2-23-2021
Permit Number: 1909-0354
Site Address: 8650 S OCEAN DR JENSEN BEACH, FL 34957 SLIP 11 AT MARINA
HARBOR BAY MARINE INDUSTRIES
Original GC, subcontractor or owner/builder
License MCMAR 02985 SLC License
State License SLC License
New GC, subcontractor
Reason for Cancellation NOT BUILT -OWNER TODD ROY OUT OF COUNTY AND NOT RESPONDING, EMAIL: Mtld@ternmIrmvgator.00 , pH 519-220A904
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, ag nts and employees from all
costs, fees or damages arising from any and all claims of action for any reason, which anse a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled vo y en performed.
SIGNATURE OF OWNER (or owner/builder) SIGNfIURE GEN CTOR (or new GC, as applicable)
PRINT NAME PRINTNAME SCOTT SAFRANSKI
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_, by
who is personally known to me
or who has produced as m.
2-23-2021
Signature of Notary Date
Revised 04/15/16
9(2,mArr) 33 4 v
.CTLvt+t'E CC), OR(;
State of Florida, County of St. Lucie County
Th f of n t was 11acl le befo me this (� � t
Y2 is personally known to
A or who has produced as ID.
2-23-2021
Signs of Notary Date
TINA BRIGGS
& -State
of Florida -Notary Puo1ic
2
Commission R GG200883
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My Commission Expires
.,.
May 02, 2072