HomeMy WebLinkAboutMisc Letters PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
a
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-
Contractor.
X 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:. 04/27/2021 Permit-Number: SLC 2009-0700
Site Address:,*6405 Oleander Ave
CRS Plumbing. State License SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation No work done (Sent Oriqinal Cancellation to Port St L
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
contra r/subco for or cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME I tr(�r)-a t.- a,—k PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
Qday of r„�. .20 Z1. .by. .. . _..._ .__day of 20_,by.
�Gr&_V_ bEC who i ersos"' l.4 known to me _who is personally known to
or o has`produced -as'ID:-, me or who has produced as ID.
Signature of Notary Date Signatu"re of Notary. Date
�°6C•. PAMELA S.CENK
Revised 04/15/ .'a(�,��-.:�- NotaryPublic-StateofFlorida
`i2\+17de�'` Commission N GG 338728
My Comm.Expires Jul29,2023
Cit
y:, °of Port SL Lucle Building artment,,De.
�+ 9 p -Permit
A m 121-,SW Port St 16cie:,Blvd- .
Port St. Lucie, R.,349.84 C a n e e I I a t i o n
772-871-5132 Web§te:www.ciyotosl.com/building . Request
Request'for Permit Cancellation
(Use:thus-form only,if work has-not started)
Permit number gl ; ppg_g7op Daw:,i4qrqo pa. 2p71
Reason:for cancellation.request:
No work done(plans;must:be at jobstte) ElWork removed(plans must-be at jobsite)-
❑ Superseded by another permit ;l]. buplrcated permi[`ntamber_ ;
- Person requesting cancelaation-is: --
B Property owner ❑ Owner's authorized agent by Power of Attorney
m Remeln Rntipds 8405 Oleander Ave
Name Permit address
_Ft_Piarrc �— 349801?
Mailing address(if different from permit address) City' State, Zip
Phone number Email (required)
1, Pamela RnhertG' ,as the owner/owner's authorized agent of the above
referenced permit am requesting,-that the permit be cancelled 1 certify that I have not performed,any work on this permit. 1
assume full responsibility for the cancellation of this permit and hold the City of.Port& Lucie, its officers, agents, and
employees, including but not limited to Building.Official(s),.harmless and without any liability for such cancellation. I
understand that plan review fees are not refundable, and-all permit fee refunds are subject to an administrative charge,per
Article Vl1-Sec: 150.701.of the City.Code of Ordinance.
'Pamela Bp
1-Z.Z�
Signature _ Print name,
State of Florida
County of St. Lucie
The foregoing instrument was acknowledged before me by means-of, ph sical presence or ❑ online
this , ""day of Ma ram. 20 Zt b C�v�net�- y who is
notar-izaHen, y, Y,
pe sonally kno n to me or has produced `��-Wrt as identification:
Notary Public,State of Florida
PAMELA S.CENK
,: �•f Notary Public-State of Florida
-Commission#GG 33 7728
FOR OFFICE USE ONLY: Refund amount approved ?°F f�`? `
PP My Comm.Expires Jul 29,2023
Revised 7/21/20 yp