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HomeMy WebLinkAboutCANCELLATION OF PERMITPLANNING & 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: 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: 9 [=d Llp_� Permit Number: 910_� - U—"IQa Site Address: u"1 U ( V )ld X )�A� I,) WU 11, V � to t :r— l= pn\:�) �)IA PlacA State License LC License Original GC, subc ntractor or er/builder License SLC License New GC, subcontractor Reason for Cancellation 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 contractors contractor lation of permit. A permit cannot be cancelled if work has been performed. SIGNATURE OF R (or o er/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable) PRINT NAME W PRINTNAME_ State of Florida, County of St. Lucie County The following instrument was acknowledged before me this ,�14-11day of S Ge. , 20 Z , by _ !��11 , 74: who is personally known to me %whq produced as ID. //-Signature of Notary Date State of Florida, County of St. Lucie County The following instrument was acknowledged before me this day of , 20_, by who is personally known to me or who has produced as ID. Signature of Notary Date Revised 04/15/16 JOAilNE'WILL6 COIiiTilSSion # GG 272613 crpi eFEbruary 20, ?023s ©onded?hTroy Fain Insurance 800.186-7019