HomeMy WebLinkAboutPermit # 2008-0776 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 tractor.
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: —_�)_
Site Address: C2051 — l00901 PJ l)
Original GC, subcontractor or owner/builder
New GC, subcontractor
Reason for Cancellation
Permit Number: e26O,� " U 7 / (e
J , '
Licensecnes '33U SLC License
License SLC License
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 cancelled if r1t has bee erfa ted.
SIGNATURE OF OWNER (or owner/builder) SIGN RE GENERA CON ACTOR (or new GC, as applicable)
PRINT NAME PRINT NAME (5ZIrnol's r1
C —
State of Florida, County of S[. Lucie County State of Florida, County ofStlhncieCounty
The following instrument was acknowledged before me this
who is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
Mwing' torment was acknowledged before me this
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�y+cyil, Notary Public State of Florida
^ Gina L Cicco
N d My commission GG 158709
diGO noF Expires 11/21/2021