HomeMy WebLinkAboutCancelPer_113CaminoPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
- - - FORT PIERCE; FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
c
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-
Cont actor.
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: �' �� Icl� oS Permit Number: c��� — U�'"I CO
Site Address:( 3 ,�1, �,Gm i n^n
V�.�0nn E��� UC�r e Cense I SLC Licens �105
in
Original GC, subcontractor or owner/builder
State License SLC License
New GC, subcontractor
Reason for Cancellation Cus bmt- Carf I kd I ass ued ibcCu nd
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 reason, which may arise as a result of this change of
o actor/subcontractor or cancellation of permit. A permit can of be cancelled if work has been performed.
IGNATURE OF QWNER (or owner ilder) SlriNATURE G RAL a CONTRACTOR (or GC, as applicable)
PRINT NAME i ✓G+ PR.TNAME_
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this W f Mowing istrument was ac �}led Pd efore me this
1� day of 20by day of f't_�20A b re
��� J
who i nally known me , who is ersonall kno
or, who sp dice _ ` %,tll�OM�s/,',/ meorwC� as io u� as ID.
SI�, �
Signature of Notary D 4�03 08 ?p?6�A v�� Signature of NotG .M�A1SSi
NOTARY n,; Q G�p3 08'?O1Fho
Revised 04/15/16 �;C� PUBLIC = �►.. °' _
ti ��b`'•' P U B L I C
•:�'
OF FLd������`� OF FLU
'��14011111n: