HomeMy WebLinkAboutcancellation permitPLANNING & 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-
Cotor.
Sub -
Contra 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:
Site Address:
Permit Number: 14 Q 7 dJ q1
C-G
C�1ff��� I
bu� 1 Je 1. !, State License SLC License
Original GC, subcontractor or owner/builder
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 dam s rising from any and all claims of action for any reason, which may arise as a result of this change of
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contracto contr or or cancellation of permit. A permit cannot be cancelled if work has been performed.
N URE ER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME _1Gf* f S S T rw S PRINT NAME
State of Florida, County of St. Lucie County
The fo Jowing iwnsstrrument�was acknowledged before me this
_&_day ofL� & nV 20�, byrs ► .ss ► r L� S
who is personally known to me
or who ha duce
1
as ID.
ature of Notary
Date 2—If
°
Revised 09
JOHNNIE HILLS, SR.
My COMMISSION ff GG 313435
�•°` "•�' Bonded
EXPIRES: July 18, 2o23
MU Notary Public Underwriters
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 ID.
Signature of Notary Date