HomeMy WebLinkAboutCANCELLATION OF PERMITPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(7/Z) 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 -
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:
Site Address: c��
Permit Number:
Chi {O Vi2f (/C SJ State Ucense G SLC License
Original GC, subcontractor or owner/builder
License SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does her agree to indemnify and hold harmless St Lucie County, its offices ents and employees from all
costs, fees or damages arising from any and all claims of action=an7ellif
ay ar' a a result of this change of
contractor/subcontractor or cancellation of permit. A permit corl be n performed.
IGNATURE OF OWNER (or owner/builder) NTRACTOR (or new GC, as applicable) ``
PRINT NAME PRINT NAME CV3 top�IQf- �gi'v�VQ i
ty
State of Florida, County of St. Lucie County
The following instnnnent was acknowledged before me this
,by
is personally knownto in
or who has produced as ID.
Signature
of Notary Dam
State of Florida, County of St. Lucie Coun
The following i�shy Went was acknowled e befor me his
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for who has produced as ID.
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Signature of Notary Date
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