HomeMy WebLinkAboutCancellation of Permit ,. PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISIO
RECIVD
2300 VIRGINIA AVE
— _ FORT PIERCE, FL 34982 FEB 12 2020
(772) 462-1553 FAX 462-1578
ST. Lucie County, Permitting
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-
' Contr or.
CANCELLATION OF PERAUT—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. 02 c-e. /-vo
p�►n,f�
Date: Permit Number:�epn 1
-Site Address: er WQOLane F6, lr2-r'G e -- Net.
State License � SLC LicenseI 1
Original GC,subcontractor of owner/builder n(
State License /v SLC License
New GC,subcontractor
Reason for Cancellation
The undersigned does h eby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages ing from any and all claims of action for any reason,which may arise as a result of this change of
ntr for/subcontract �rn of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF ER(o owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME 16IMr" b K M941 OE4 PRINTNAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The oliowing" t was acknowledged me this The following instrument was acknowledged before me this
da of 20 day of 20 by
Y _�Y
ho is pers ally known to me who is personally known to
� f7 �,�9 _ me or who has roduced as ID.
Pn'uP
4igAnaturef Notary Date Signature of Notary Date
Revised 04/15/16 :�"Y' SHIRLEY K•BEMEWERFER
* Commission#GG 949510
D 2024
Expires May 8,Borded Ttuu Tmy Fain Insurmce 8*38r7019