HomeMy WebLinkAboutCANCELLATION OF PERMIT_ PLANNING & DEVELOPMENT SERVICES
�, `- = BUILDING & ZONING DIVISION
COUNTY 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 *ignature. 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 -
Con rector.
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: 1 D 11(1 12m Permit Number:
Site Address: 4q Z S 1\1afol-n1 4V_e_ .
State LicenseL LJ 5175`71 SLC License
Original GC, subcontractor or owner/builder
New GC, subcontractor
Reason for Cancellation '�Ao �pngp( h
State License SLC License
SoS1-Coke .
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its of
costs, fees or damages arising from any and all claims of action for any reason, which may
rYlo t etorlsubcontractor or c�yncellation of/m,it. A permit cannot be cancelled if worly
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PRINT NAME' JIi l T / A !(, !/V
State of Florida, County of St. Lucie County
The following instrumen„ tt acknowledged before me this
o day of 200�`, by_2!�A6L
L who is personally known to me
or who has producedas ID. �
Signature of Notary Date
i3*! LINDAI. DUPLESSIS
1
Revised 04/1 1* MY COMMISSION# HH 143016
m 'a EXPIRES: October 15, 2a25
Bonded Thu Notary P.Wic Undetwr#9rs
-s, agents and employees from all
as a result of this change of
been Derformed.
SIGNATURE GENERAL N TOR (or n ,as applicable)
PRINT NAME h[ AYV'IC eU
State of Florida, County of St, Lucie County
The following ins Tent was acknowledged before me this
�Q�s day of }�®V , 2G 21, by irk
-0P,; � i who is personally know to
or who has produced as ID.
I[ l
Signs re of NotaryDate
Notary Public Ststeylcn of Elands
Crystal E Naylon
nCommission GG 929549
Expires 11/m2o23