HomeMy WebLinkAboutPermit Cancellation_2011_0368_20210525_15340706- - 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 -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.
C cellation 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: 5/25/2021 Permit Number: SLC-2011-0368
Site Address:
Pride Electrical Services of FL
Original GC, subcontractor or owner/builder
New GC, subcontractor
Reason for Cancellation Did not perform work at this address
License EC 1300-5859 SLC License 29875
License SLC License
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,
costs, fees or damages arising from any and all claims of action for any reason, which
contrac�tor/subc�oninctor cancellation
�o�yfp�e�ot e rmit. A permit cann
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SIGNATURE OF OWNER (oer) GENERAL (
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
20_, by
_who is personally known to me
or who has produced as 11).
5/25/2021
Signature of Notary Date
Revised 04/15/16
PRINT NAME Michael Pride
enta and employees from all
as result of this change of
e performed.
1 tar newli GC. as aoolicablel
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
a�!l—day oftV, 20di,by M%%t_%W
-cl ' L
Y who is personally Imown to _
who ku produced as To.
+ � 1 05/25/2021
Signature of Notary Date
k(AREN D'ONOFRIO
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. `- V-q. EXPIRES: August 5.2022
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