HomeMy WebLinkAboutcancelation of permitPLANNING & 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-
Contr ctor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Canc llation 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:
1-02 1 Permit Number:
State License SLC License
Original GC, subcontractor or owner/builder
State License SLC License
New GC, subcontractor m 7AASfi
Reason for Cancellation
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The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs'm es or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
con ac or/subcontractor or ca 11 ' n of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF O� � R (or ow/ ner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME J. C PRINT NAME
State ofllerida, County of State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
JD-' -day 0(12 , 20 Z-i , by-�AA�e c
`VLF-J(Z who is personally known to me
or who h uced XI U0/�as ID C�h
Signature of Notary Date
The following instrument was acknowledged before me this
day of , 20_, by
is personally known to
me or who has produced as ID.
Signature of Notary Date
---�" Seat
Revised 09/15/16 GommonwealthofPennsylvanla -Notary
Sandra Let; Cox, Notary Public
Delaware County
tvly corm )Mission ss�on nurr ber 12203.0 20'L2