HomeMy WebLinkAboutVoid Letter PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
COUNTY 2300 VIRGINIA AVE
iF�..LORI
a... ._.,�.... FORT PIERCE,FL 34982
(772) 462-1553 FAX 462-1578
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$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and.notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 6 262, 1 Permit Number:
Site Address:162)C6 .A)Ay#" Vl .'Rx.4 f1IG , r�. 314 q$
.&C[ S;dg A ZIA411. (Ze✓A;,% IuQ, to State License SLC License
Original GC, subcontractor or owner/builder
tate License C S SV4 SLC License
New Gd,,subcontractor
Reason for Cancellation N p �+,( K � {J•'}�.� � G�/►nQf ,
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
contractor/subcontractor or cancellation of permit.A permit cannot be ca elled.if w h erformed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME PRINT NAME, I�F
State of Florida,County of SL Lucie County State of Florida,County of SL Lucie County
The following instrument was acknowledged before me this The Bowing t was acknowledged before me this
day of 20�by Z�,11 of ,20�,by r70
who is personally known to me who is personalh,knn_to
or who has produced as ID. mG gR wh ha rodue as ID.
12s/2t
Signature of Notary Date signature of Notary Date
Revised 04/15/16 Notary public StstsofFtonda
Michael H Anderson
;, Mw Lly mm11012 G 309707
�y� Expires 03f102023