HomeMy WebLinkAboutcancellation of permit - - PLANNING &DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEIVED
®i
2300 VIRGINIA AVE MAR 15 2021
- - FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 PerSt.Luccie Courrk'/ant
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-
Co tractor.
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: / r��Jd'( Permit Number:
Site Address: S- f q'11? Sk- P/ 3`i1
II)A l State License SLC License-
OriginaC6C,subcontractor or ownneLr/builder
State License SLC License
New GC,subcontractor G
Reason for Cancellation (�C tm(/L i U{'L CCf!/ 4Vl W C:�-
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 ca celled if work has beeverfor ed.
IGNATURE OF OWNER 'r owner/builder) SIGNATURE GENCONTRACTOR i(KGC,asa hcable)
PRINT NAME alljf �J Q/)✓�G� PRINTNAME �i
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
e following i trument acknowledged before me this The following instrument was acknowledged bef re me this
1 day of 20�,by day of ���� ,20�,by �r t C t C— k
/(r'-0 ha is personally known to me who is personally known to _
o ho has produc ft, � s ID. In Lh. apwd, EL(7L as ID. t✓ wo
(/ Signature of Notary Date Signature of Notary Date `����01�'�•',etS 1St 4svn7g�d�6'��i
VIVIENNE A.PINLEITER a :�z b9486199# °g; Z
Revised 04/15/16 �10 p Notary Public,State of Florida _ � : Mo-o® —
Commission#GG 133001 • s�, a
My comm.expires Aug.11,2021
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