HomeMy WebLinkAboutDunck Permit Cancellation FormPLEASE 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-
Controctor.
,f ' T" 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: 2/24/21
Permit Number: 2101-0272
Site Address: 5051 NORTH HIGHWAY A1A BLDG C UNIT 3-1, FORT PIERCE, FL 34949
ELITE ELECTRIC AND AIR
Original GC, subcontractor or owner/builder
State License CAC1816433 SLC License
New GC, subcontractor State License SLC License
Reason for Cancellation CUSTOMER CANCELLED BEFORE WORK STARTED DUE TO FUNDS
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 cance lation of permit. A permit cannot be cancelled if work has been performed.
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SIGNATURE OFER (or owttet/bu' der) SIGNATURE GENERA CONTRACTOR (or new GC, as applicable)
PRINT NAME fa( PRINT NAME _
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State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day oll NO 1 by
who is personally known to me
or who;ha pX•_duc _d , ,- e as ID.
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Signature of Notary Date
The following instrument was acknowledged before me this
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—L"-day of C? iC) CiB, 20.1, by2LD
1 b tad g`e` 1
who is personally known) to
e or who has produced as ID.
2/24/21
Signature of Notary Date
KONNI LEeNAE DEWI TT
Pie , Notary Public — State of Florida
Revised 04/15/16 ;2* "» Commission # GG 166915 KONNILE.NAEDEWITT
N Comm. Expires Dec 10, 2021
"a ` It ■�� My ; =e fi o Notary Public — State of Florida
X Bonded through National Natety Assn. c� Commission # GG 166915
' ""' `. �" 511tiu,j off` tJ�y Gomm. Expires Dec 10, ?.021
''�;F�Ff;;:�•' Bonded through National Notary Assn.