HomeMy WebLinkAboutVoid letter request Nov 09 21 12:52p SOLAR ENERGY SYSTEMS 772-466-7937 p.1
I
PLANNING & DEVELOPMENT SERVICES
BUILDING i& ZONING DIVISION
2300 VIRGINIA AVE
�__...... _......:.. FORT PIERCE, FL 34982
(772)462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBC 11 NTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF TIRE FOLLOWING:
CHANGE OF CONTRACTOR—Changel f Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current pert�it. A new permit application must also be completed with newcontractor 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 A16 Change-out). A recorded copy must be submitted prior to
commencing any work.There is a$50,00 fee for th�Change of Contractor.
CHANGE OF SUBCONTRACTOR—Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor greement Form.There is a$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERMIT—The ca ii i�cellation 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: l C_�G C-31+ Permit Number: �` C� ` G
Site Address: �� �ZO F)C r'C Ft 3149 K I
J
I State License SLC License
Original GC,subcontractor orowner/builder �
_ State License SL;C License
New GC,subcontractor
Reason for Cancellation Cos+t)tY1 17�'ic'� �` P.✓-e M /n CY
The undersigned does hereby agree to indemnify and hol harmless St LLICie County,its officers,agents and employees from all
costs,fees or damages arisinL from any and all claims of ction for any reason,which may arise as a result of this change of
tractor or cancellation of permit. A er it cannot be cancelled if wortsAblipen erfarmed.
contractor.subcon F p P
I �
SIGNATURE OF OWNER(or o%wer/builder) /SIGN.AV REGENERA LRACTOR(or new
1GC,asapplicable)
PRINT NAME PRINTNAMl_
State of Florida.County of St.Lucie County State of Florida,County of S:.Lucie County
The°ollowing instrument was acknowledged before me this '1161tbllowinb instrument was acknowledg-d before me ibis
day of 20_,by _day or �+rG�� 20 af,by ' (:T
who is personal:y known to me y' I c3r__k�who is arso Il�kn to
or who has produced as ID. me r who has pr duced as ID.
Signature of Notary Date I Signature(if Nob" ttc
Revised 04!15/16 Nar, Notary Puhlia State ofFlorida
Kimbeny Large
S G p My Commission GG 942752
eta�d� t xp'ues 12/26/2023
I
I