HomeMy WebLinkAboutcancellation noticePLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 4624553 FAX 4624578
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONC 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 Subm
Cont9ft for.
ANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Ca cellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
ca cellation of the permit.
Date: 07/07/2021
Site Address:
Parasdise Exteriors Roofing, LLC
Original GC, subcontractor or owrrer/builder
New GC, subcontractor
Permit Number: sLc-2loa-a35s
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License CCC1328522 SLC License
License SLC License
Reason for Cancellation Extensive damage to the home/roof. No work has commenced
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.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME
Slate of Plmida, Coanry of St. Lucie County
The following iasnument was acknowledged before me this
day of 20� by
or who has
Signature of Nofary
Revised 09 /15/16
who is personally known tome
as M.
07/07/2021
Date
SIGNATURE GENERA TRACTOR (or new GC, as applicable)
P121NTNAME Dan Beckner
ty
State ofFlorida, County of St. Lucie Coun
The followiug iu tmu ent was ackuowl let�i�ec
day of l_, 2lbt�, by'v�
Signature
personally kno�m
07/07/2021
Date
'�"��`�•��°: CAI7LIN REUL
MY COh1MISSION tF I�IH OG5595
�9,:�.o,' EXPIRES: November 19, 2024
`• BondedThru Notarypu6lic Undervmlers