HomeMy WebLinkAboutholder cancelled 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. Anew 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-
CCongja }ctor.
ANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Capp((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: / Permit Number: C7
Site Address: S Q (
G k ('' S j e j cM q 12 A State License t t CU 5)C License
Original GC, subcontractor or owner builder
State License SLC License
New GC, subcontractor
Reason for Cancellation
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 a cancelled if w di has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR C{(or new GC, as applicable)
(J
PRINT NAME PRINTNAME C - e r
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
is personally known tome
or who has produced as ID.
Signature of Notary Date
Revised 09/15/16
Stale of Florida, County of St. Lucie Cowr
lire following �nSh{�ment was acknowledped before me his
$ day of JWh1 ,20%:, byCY1(IS f
�+WNICA
who is Dersonally known to
yy or who has produced " as ID.
& 14 1 d �',l' wLk
Signature of Notary Date
�,�+�� Netary Public State of Fbrioa
Lima H Broome
My Commission GG 221497
'Mh Expires 0=312022
ort Pierce, FL :r
r #
Curtis Holder
5301 Indian bend In
Fort Pierce, FL 34951
Regarding permit#2105-0733
Customer Curtis Holder at address 5301 Indian bend In cancelled new a/c replacement and said they
were going with another a/c company. If any work has been down at this address, Seacoast A/C did not
do it.
Christopher Langel
President