HomeMy WebLinkAboutRhyant Cancellation FormPLANNING & 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 PERNIT
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.
X 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: 8/30/21 Permit Number: SLC 2103-0818
Site Address: 201 37th St. Fort Pierce, FL
Code Red Roofers, Inc
Original GC, subcontractor or owner/builder
New GC, subcontractor
Reason for Cancellation Client cancelled contract
License CCC1326574 SLC License CCC1326574
License SLC License
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
contr for/subcontr r or cancellation of permit. A permit cannot be cancelled if work has been performed.
ATURE OF O R (or o uilder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME E'i "o, PRINT NAME 111WRIA1 E . ROE
State of Florida, County of St. Lucie County
3 aay
ing i strument'w✓assaacknoo /wledge efore me thA
of GV 20 4'l , by
who is personally known to me
or whd L.4rduQed as M. I
Signature of Notary / Date
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
�jZ/!►dayof.2pt' 202Lby
.!/T_ dE/ who is personally known to
me or who hasp oduced as ID.
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Signature of Notary Date
Revised 04/15/16 vCASSIETTABRADLEYSANDERS Notary Public State ofFlortda
*, *: MY COMMISSION # HH 16020 i �; Brandon J Smith
EXPIRES: July 28, 2025 My Commission HH 155978
Expires 08/23/2025
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