HomeMy WebLinkAboutCancellation of Permit PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
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2300 VIRGINIA AVE
- FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCEL"NTION 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: 7-21-21 Permit Number: 21060383
Site Address: 309 Rosewood Dr. Fort Pierce, FL 34947
NA State License SLC License
Original GC,subcontractor or owner/builder
N/A State License SLC License
New GC,subcontractor
Reason for Cancellation Owner has decided to build a different project(new application to be submitted)
Tile undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs,fees or damages is ng from any and all claims of action for any reason,which may arise as a result of this change of
contractor ubcontrac r r cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OFes
R(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAM B.Oppenborn PRINT NAME N/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
23 day of 1' 20 21 ,by 1CDJr day of ,20_,by
_� who is EEsona kno to me who is personally known to
or who has produced as ID. me or who has produced as 0.
�R17L n,r7Ji� � QuoQ� 7-21-21 7-21-21
Signature of W10tary Date Signature of Notary Date
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