HomeMy WebLinkAboutChangeofContractorCancell 3100 St Lucie Blvd Fort Pierce FLPLANNING & 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.
______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:Permit Number:
Site Address:
State License SLC 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 be cancelled if work has been performed.
_______________________________________________ ________________________________________________________
SIGNATURE OF OWNER (or owner/builder)SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME PRINT NAME_
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
day of , 20____, by day of , 20 , by
who is personally known to me who is personally known to
or who has produced as ID. me or who has produced as ID.
Signature of Notary Date Signature of Notary Date
Revised 04/15/16
contractor/subcontractor or c
______________________________________________
SIGNATURE OFO OWNER (or own
cannont be cancelled if work has be
_________________________________________________
SIGNATURE GENENRAL CONTRACTOR
16
Date
orrrrrrr who has produced d me oroooooooo who has produced d
XX
3100 St Lucie Blvd Fort Pierce FL
7-14-21 2005-0207
Sunrise City Concrete Services Inc CGC1515114
Car lift was removed (Code violation case)
Roderick Waller
Roderick Waller
14th 14thJuly21 July 21
Roderick Waller
Roderick Waller
7-14-21 7-14-21