HomeMy WebLinkAbout3331 IRONWOOD CANCELLATION FORMPLANNING & DEVELOPTME\T SERVICES
j BI'ILDI` G & ZONING DINZSIOv
2300 VIRGIN IA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CILA`GE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION. OF PERMIT
PLEASE SELECT ON-E OF THE FOLLONN'1\G:
CHA-NGE OF CO\TRACTOR — 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 inforiiation and signature. A new .Notice of C'olmnenceinent must be filed in the new contractor's name
for job values greater than S2.500 (S 7.500 if A C Change -out). A recorded copy must be submitted prior to
conuiiencing any work. There is a S50.00 fee for the Change of Contractor.
CHANGE OF SLBCO\TRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a S50.00 fee for the Change of Sub -
Contractor.
C 'A--CELLATIO\ OF PERMIT —The cancellation of a permit is acceptable only if no work has been done.
Cancellation of pentut is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: // ZI/ E I
Site Address: 3 _;�>61 i rhn1 Lryi�c l
Permit Number: 2 1 CAW_ — C 7_ Rj�
State License z8,�6ASLC License
Original GC. subcontractor or owner builder
State License SLC License
New GC. subcontractor ( L-i L- WC rl D P EF0i\4[J'
Reason for Cancellation N,ly�,�/y�i� �0QO� A t 1 �n((, OX �U'
The undersigned does hereby agree to indenuufy and hold harness St Lucie Count-. its officers. agents and employees froin all
costs. fees or daniages arising froin atie- and Al claims of action for any reason. which may arise as a result of this chance of
contractor subcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGN-A-r RE R (or otrtter builder) SIGNATURE URE GE` \ RaCTOR for GC_ a; applicable)
State of Florida Count- of St Lucie Counn-
PRL\T '\.A-N E_ /,50cw- g
State of nonda. Counn- of St_ Lucie Counn-
The following instrument %xui acloion-l-deed before me this The foIlo«ing instrument was acknondedeed before me this
_jdav of Gt�6 G Z! . be �! day of A _ 'C �/ be
—p_r�� _ —
���ito is persottaily knrn�n to me _41 a � �,�n4io is personally kno-on to
or %vho has produced*ffjy jig 2b as ID, me or cNito has produced Wqtas ID
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gnature of \otan- Date ` . ignature of \otan' Date l
,.;�.P; KIARA S FIGHROA KIARA S FIGUEROA
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_ a:° �,:, Notary Public -State of Florida iP 'Notary Public -State of Florida
_ Commission # HH 51970 Commission # HH 51970
My Commission Expires %�Y�°`� My Commission Expires
October 08, 2024 ''��a����` October 08, 2024