HomeMy WebLinkAboutVOID LETTER 561 FAX 08:49:30 a.m. 07-16-2021 111
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578 JUL 16 2021
fit,Lucie County
Permitting
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.
_1.,��<ANCELLATiON 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.
e
Date: t, )Lf c Permit Number:
`--)
Site Address: 530 ) H-t-i M r, . n e,t- }
F Gtr c State License SLC License OV t��PCiQ
Original GC,subcontra for or owner/builde
State License SLC License
New GC,subcontractor
�
Reason for Cancellation a•.L C`�-� I/Yl �_r 210 C cam-I r Q
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 real ,which may arise as a result of this change of
contractor/subcontractor or cancellation of permit.A permit cannot a elled' work has been performed.
a
SIGNATURE OF OWNER(or owner/builder) SIGNZAT76RE GENtRAL CONTRACTOR(or new GC,as applicable)
PRINT NAME PRINT NAME-N to�-l� L>t,(LI-A
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 L.1�,:S-day of J a f 20� y b
[" 1 who is personally known to me A M. S 6-&"(i -1 who i e[sonall know o
or who has produced as ID. me or who QVroduced as ID. _
Signature of Notary Date Signature of Notary Date
"" GABRIELLE HICKS
gg,
Revised 04/15/16 �y4� ° Notary Public-State of Florida
=•®•= Commission 0 HH 79602
%5 c`
My Commission Expires
"iii o" February 02, 2025