HomeMy WebLinkAboutcancellation noticePLANNING & 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.
Xm,oss, 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: 06/24/2021
Site Address: X 2510 S Brocksmith RD
James Player DBA Carports Anywhere
Original GC, subcontractor or owner/builder
New GC, subcontractor
Permit Number: 2104-0634
State License CBC1251995
License
State License SLC License
Reason for Cancellation Customer not moving forward with project, cancelled order
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 work has been performed.
17)
SIGNATURE OF OWNER (or owner/builder) SIGNATURE CONTRACTOR (or new GC, as applicable)
PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_ by
who is personally known to me
or who has produced as ID.
06/24/2021
Signature of Notary Date
Revised 04/15/16
PRINT NAME_T01^'e S
State of Florida, County of&-imme43etmry B R40P'4R D
e llowing insttru�mmentwas acknowledged before me this
/- day of LM-W E . 202(, bye .4M CS
who is personally known to
or who has prodpVd A as ID.
Signature of Notary ate
irf MARIA R. BURGIN
Commission # GG 362849
Expires AUgusi 25, 2023
:..!... Bondod Thru Troy Fain Insurance :800-385]-7019