HomeMy WebLinkAboutVOID LETTER R�cN PLANNING & DEVELOPMENTS
BUILDING & ZONING DIVISION
WE1rAVYED
' 2300 VIRGINIA AVE
JUL 2 3 2021
FORT PIERCE, FL 34982 -
(772) 462-1553 FAX 462-1578 permitting Department
St. Lucie County, FL
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.
CHANCE 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.
Ca ce lation 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: 00 - 057
5-
Site Add Cr—
ress tD—Ci
State License E1oq S LC License e----
O ' a GC,subcontractor or owner/builder
iv- Al Ik SLC License
New GC,subcontractor
Reason for Cancellation
The undersigned does hereby agre to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or dam a ' ing fr any and all claims of action for any reason,which may arise as a result of this change of
contract o u a for r ca ellation of permit.A permit cannot be cancelled if ork has been performed.
SIGNA OF VINE owner/builder) SIGNATURE GENE AL CONTRACTOR(or new GC,as applicable)
P T 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 j'�e foo wing instrument was acknowledged before me this
day of �. 20�,by�C( V S t� ` ��aaY of ,20�(,by'�� t/1
OA-e SGh U,1L who is rsonally kno to me Z� J who is pemo�III kt�wn to
s produced as ID. me or w a roduce � rS a�s I� �V 1�
Si ,lure o, otary Date Sign Lure of Notary Date
Revised 04
ao< Yeye�c," PATRICIA ANN CHACON ,=o{ �P�XT
; PATRICIA ANN CHACON
,- MY COMMISSION#GG 361474 F.
MY COMMISSION#GG 361474EXPIRES:Au ust 1,2023 �. EXPIRES:Au usF' �P' 9 'FOFF�o 9 t 1,2023
9F Ft.• Bonded Thru Notary Public Underwriters Bonded Thru Notary Public Underwriters
Fa���.,.