HomeMy WebLinkAboutCancellation of PermitGj
PLANNING & DEVELOPMENT SERVICES
BUILDING: & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE. FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR SUBCON'I'R 10*011 OR CANCELL 1TION OF PERM
PLEA.SL SELECT ONr OF THE FOLLOWING;
CHANGE OF CONTRACTOR - Change or Contractor is to he 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 ,lob values greater than $2.500 ($7.500 if A,C Change-ouO. A recorded copy must he submitted prior to
commencing any work. There Is a 5:50.00 fee for the Change of Contractor.
4
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-
Contr tor.
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.
1k Date: to -.26- �2 1 # Permit Number: a01 1 - OcP 9? y
)h Site Address: l 19 I S 3 a,j, -K 4%. qe,r IJr' d 2 \TenSewl beo c_- '
Ste^` State License SLC License
Original GC, subcontractor or owner/builder
'Te \ Agovie'"sState LiccnseCCC133.R34(oSLCLicense
New GC, subcontra or, r
�f Reason for Ca ell +onr''
The undersigned does hereby agree to indemnify and hold harmless St Lucie County. its officers. a pts and employees From
costs, fees or damages arising from any and all claims of action for any reason, which ma esult of this change of
cornraclorubcorAcuFncellation of permit. A permit cannot be cane gl ed as been performed.
GNATU E O or er/bulider)
N : (jL'NE^R}AALL CNNORACTO1oRtw new Cd. as applicable)
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PItINI'N.•\41F._xV1nL.. y� -ya___
PRINT NAME-
Wa.w sA,
State arjawma. County of
State of I9onda. Chanty of St. Lucie County
The Oallowing instmmem wets acknowledged before me this
day of '0 �/� by_ i�%"t V-
The following instrument wm%acknowledged before me this
-_ day of A&(jVbgg! . 20R. by 1>JI CC
_,% who is Personally known tome
_ - wMa is txnanally nnwn t
or who ltas r ua1dJL5, TD6�id/ Gk- ID.
—TI
m I who, odmc ae ID.
.l7�
Slasalu �- Date 10 7,&p .�al
Signsture of Notary D.n
NOTARY PUBLIC
HEATHER ADAMS
COMM. # 704687
COMMISSION EXPIRES
FEBRUARY 19, 2023
STATE OF UTAH
WON* PER nNZP
�pmm15 for .8
My COMM. Exnves "^ 2S [i--
BorGec through Namora'j Notary ASSr.