HomeMy WebLinkAboutcancel permitp?'(Mets(a' S+-IQ6eCCQ ��t
PLANNING & 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-0ut). 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 -
Contractor.
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: 2021-4-2
Site Address: 1704 Edgevale Road, Fort Pierce, FL 34982
Original GC, subcontractor or owner/builder
New GC,
Reason for
The
costs,
(or
any
County of SC Lucie County
tacttMring insummenutvas ackn edged before me this
i
_day o _ . 20 , by
______.._ .,who is Fersonal3Y knolm to
or o as produced_ av
21-4-Z
ignature of Notary Dute
Permit Number: SLC 2012-0148
License SLC License
License SLC License
the re -roof. Coating does not require permit.
ad hold harmless St Lucie County, its officers, agents and employees from all
nu of action for any reason, which may arise as a result of this change of
A permit cannot be canceil . ' ork has been performed.
(or new GC, as applicable)
PRIM NAME- ✓kJ c e'
State of Florida, County of St. Lucie County
The foltnwin m e t�ae acknowledge�d before me this
g g
? dayofm,26af,bylJC/fCe—
✓W hn is racially kii to
wiw has prod ed as
to, —
2021-4-2f
Signature u Date
Revised 04/15/i5 oat`Y °6s� Notaryotary P in of Florida,,,-
i Brenda J Keeney rota 6o THERESA JAFFE
t taly Commission GO o3939e / l�cJ Notary Public-Stateofrlorida
yor oo� tr.P'ea e772212021
m e t Commission 46G 202301
My Comm. Expires Apr 1, 2022
Bonded through National Notary Assn.