HomeMy WebLinkAboutCANCELLATION OF PERMIT PLANNING&DEVELOPMENT
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BUILDING�'&ZONING D"IO
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2300 VIRGINIA AVE
OCT 26 2021
FORT PIERCE,FL 34982
(772)462-1553 FAX 462-1578 Permitting Department
St, Lucie County, FL
CHANGE OF CONTRACTOR..SUBCONTRACTOR OR:CANCEL TION OF PERM
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 mus (also be completed.with new
contractor information and signature. A new Notice;of Commencement must be filed n 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 Q.O.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.,0 fee for the Change of Sub-
Contractor.
._CANCELLATION OF PERMIT—The cancellation of a permit is acceptableonly if no work has been done.
Cancellation of permit is to be signed and notarized.by both the owner and qualifier.df,record. There is no fee for
cancellation of the permit.
ii
:Date: !o i x'o i 6 A Permit Number: ELL
Site Address:
,!(���
- i i t i itaji t� �State License .____ `lLC License
Original GC,subcontractor or owner/builder
State'License LC License
New GC,subcontractor ( �,
` t }'
Reason for Cancellation )
gn y agree to mdemn fy.and hold harmless St Luc County,its officers; 'gents and employees from all
The undersi ed does hereb l `"ie
costs,fees or damages arising from any and all claims of action for any reason,which may arise, `a result of this change of
contracto subcon or or canc§flatiqn of permit A permit cannot be cancelled of work has n performed.
SIGNA E OF OW((N��EJ (or owner/but der) SONATURE G E CONTR(ACT�O -{or n GC,as Applicable)
PRINT NAMks �}1' 1, a PRINTNAMEv L
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie Co
'Me following instrument was acknowledged before me this ollowing spurn t was aclmowledg before me this
da o 20 a by y of ' ' 20
YI
who is personally known to me. who is pe a0y,ttnoYtizkto
or who has'prod ul
d D�L as ID. me or who has cedas
Signature of Kota'." Date1 j Signature of Notary Date n €1 1
V ��a /i79yE(;ANY M. HI
GGINS T1FFAtY M. H�GG1�S
- S ,�uurr�
a=o ,Notary Public-State of Florida `os,Rec�a`yNotary Public-Stet`of Florida
•_ Commission#HH 38358 �_ Commission#+ H 38358
^+.urw°q',.` My Commission Expires' M Commission Expires
`.'�a,u,•• 'September O'1.,2024 °v anr��� y
�; September 01 2024
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