HomeMy WebLinkAboutCANCEL REQUESTPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CON' IZAC'1C'OR SUBCONMACTOR OR CA.NCEL);,,&rION OF PERZ' T
PLEASE SELECT QNE OF THE FO p1V NQ;.
CHANGE OF CONTRACTOR —Change of Contractor is to be signed and notarized by the property owner,
attd the new contractor of record for the current permit. A new pertnit application must also be completed with new
contractor information and signature. A new Notice of Commencement must be died in the new contractor's name
for job values greater than $2,500 ($7,500 if AIC Change -out). A recorded copy must be submitted prior to
commencing any work There is a MA4 fee for the Chauge of Contractor.
CH&N- GE OF SUBCONTRACTOR — Subcontractor changes are.to be completed by the general contractor.
Tl a now subcontractor trust fill out a Subcontractor Agreemeat Form. There is a $50.00 fee for the Change of Sub -
Contractor.
CANCELLATION OF liaERMIT — The cancellation a pe
rmit ermit is acceptable drily if no wo& has been done.
ancellation of permit is to be sighed and notarized by both the owner and qualifier of record. There is no fee for
ca ncellatioa of the permit. �yDate: Z7 ra- �b Permit Numb-_r: 1903 — C.l t-5 0
Site Address,
l l 1 Q + L."e. e_ a A�
State License SLC Licenso
Original GC, subcontractor or owner/builder
State ]_,icense SLC License__
New GC, subcontractor -
kcason for Cancellation LJti r IC ✓1
v
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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 roason, which may arise as a result of this change of
contractor/subco raptor or canoeilation of permit. A permit cannot be caacelled if work has beck performed.
i
$I Xi OF W {or ttwneri'buil r) S)GNATl1Rr GENERAL CONTRAG'I,ag (or new GC, as uppticablc)
PRINT NAME � PRINT NAME
Slate of Florida. County of St Lucie County Statc of lorida, Qvilty of$t. Lucie County
71)a rolIDINing instrument was ecknowlodged before me this
_who is personally XA"'n to Me
or o has produced F as m.
Sign:ttdre nf Nainry Doll:
ARvised 00./15/16
'ats 1. wp& CARTER
t; commission#H11119742
`« Expires May 17, 2025
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Tyre foliowing instrumcM wuv acknowledged before cae this
day of--- ?Q_ by
vilo is personally kno»'n to
{tle or %vho has l;sadarcd, us 11).
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