HomeMy WebLinkAboutPermit # 2008-0774 CancellationPLANNING & 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 -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 ractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
ancellation 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: + CP-
Site Address: OcI q N us 14,
St
Original GC, subcontractor or owner/builder
New GC, subcontractor
Reason for Cancellation
Permit Number: a olos — c) 7 /
L�._tl 1-
t 3co-MALC Licensed
License SLC
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 cancello if work ha en p ormed.
SIGNATURE OF OWNER (or owner/builder) S ATURE GENE`IL C9 ACTOR (or n .w GC, m ap—plic�abllee)
PRINT NAME PRINT NAME
State of Florida, County of St. Lucie County State of Florida, County offtr ty �_h
R°Low
The following instrument was acknowledged before me this
day of 20_
_, , by
who is personally known to me
The fallowing in*u!Qent was ack"Iedged before me this
, ay of , 20 "tom b�
�'� tail personally knor
or who has produced as To.
7 o has prod
Signature of Notary Date
gnature of Nota Date
Revised 04/15/16
aVr . Notary Public StIt, of 1U
a� Gina L Cicco
My Commission GG 15a709
�p wJ Expaastit21/2021