HomeMy WebLinkAboutREQUEST TO VOID LETTER PLANNING &DEVELOPMENT SERVICES
BUILDING�Si ZONING DIVISION
�' 2300 VIRGI} U AVE
FORT PIERCE,FL 34982
(772) 462-15 3 FAX 462-1578
CHANGE OF CONTRACTM SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR—Change. f Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current pe t. 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/1 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 PERAM—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.
/G
Date: _,� , /y/ a20o2 / Permit Number: �2/0
Site Address: 6 7D Sei"e / -c:�
State License SLC License
Original GC,subcontractor or owner/builder
State License SLC License _
New GC,subcontractor �
Reason for Cancellation /l�0/1/ O�IvCt lcp., c e�Je� b ,>+.�j2�c O� are
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�ction for any reason,which may arise as a result of this change of
contractor/subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
% OF OWNER(or er/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
P NT NAME_J�;M PRINT NAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following inskus was acknowledge
fore me this The following instrument was acknowledged before me this
day of y ,2Qaols
b day of .20_,by
w p allyknowa tome who is personally known to
or wh&has produced - ( `r' 11M me or who has produced as ID.
Signature of Note Date V Signature of Notary Date
AUDREY B.HUMPHI EY
Revised 04/15/16 � t ' += MY COMMISSION it GG 300817
r =` EXPIRES:March 6,2023 f 7F
G'' Bonded Thru Notary Public Undewritar- ;`?