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HomeMy WebLinkAboutCancellation.Formcoujwry F L 0 R I V A 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 - Contractor. x 9000- 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: 1,q) q J :� t? _7') Site Address: X 4000 Edwards Road Permit Number: SLC 2101-0536 'S ���� ' C- o TsV &6, Wi'4,IState License 6-6 3nD72D,3SLC License Original GC, subcontractor or owner/builder New GC, subcontractor Reason for Cancellation Not needed 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 ail claims of action for any reason, which may arise as a result of this change of contractor/s za= permit. A permit can a can lled if work h been performed. SIGNA'I'[Jltl OF SIGN G RAL CONTRACTOR (ornew GC, as applicable) PRINT NAME William Hardman State of Florida, County of St. Lucie County The following instrument was acknowledged before me this 'ice' day of �u n t 20 _J by i - •7 u ed m g A who is personally known to me Wrwhas produced � ID• Gy?� Signa a of Notary Date Revi s=RandelPh c State d Flaridec©anion GG 352355'a 7�120i3 NANIs Joseph E Herndon Sr. State of Florida, County of St. Lucie County The following in ent was acknowledged fore me this j day of+� 20?� by�+� 1.5 L-Iern dfjh Sr _who ispersonally known to me or h4has, oduced a Signaturary Date err• r+,y� Notary Public State of Ficuids F Randolph McDaniel my commission GG $52355 3sai "00* Expires 09/07/2023