HomeMy WebLinkAboutCancellation , due to illness , customer will not do this projectRECEIVED
PLANNING & DEVELOPMENT SERVICES MAR I X 2021
BUILDING & ZONING DIVISION Permitting Dapartment
2300 VIRGINIA AVE St. Lucie County
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-
Conttrrctor.
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: o�
Site Address:
Original GC, subcontractor or owneribuilder
New GC, subcontractor
Reason for Cancellation LI.,/ ZL nv'
Permit Number:
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License SLC License
State License SLC License
S�luR,
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 cancellation of permit. A permit cannot be cancelled if work has been performed.
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SIGN TURE OF OWNER ( owne /builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME 1 I'1 f^PRINT NAME
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following mstrumen was acknowledged before me this The following instrument was acknowledged before me this
day of, 20Z, I , by--+ day of . 20_, by
(3rq( who is personally known tome
or who l�1J oroduce k�' as ID.
who is personally known to
me or who has produced as ID.
Signature of Notary U Date Signature of Notary Date
QYP� ELLEN VAUGHN
Revised 04/15/16
:oState of Florida -Notary Public
;� �=
_. Commission # GG 270079
AY;
MyCommission Expires
�����OF c�BT` 9ctober 22 2022 __ -