HomeMy WebLinkAbout2111-0017 cancellation permit requestPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
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 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/C Change -out). A recorded copy most 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 most fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
-"—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: 1112=021
Permit Number: 2111-0017
Site Address: 7821 HORNED LARK CIRLCE, PORT ST LUCIE
KYLE WHITE State License CCC1325895 SLC License CCC1326895
Original GC, subcontractor or owner/builder
State License SLC License
New GC, subcontractor
Reason for Cancellation annev-W it 2 Mnnl" hcxkk,
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees fror
costs, fees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit A permit cannot becancelledif work has been performed.
! (�
S[(-NATURE OF OWNER (or owner/budder) SIGNATURE GE/IN�/ERAL CO11NlTtR,�ACfIOeR (or new GC, as applicable)
PRINT NAME FRA?NA I ly� L II mil.
was ofRodda, County of St Lucie County
The followinginstrummt was adartmI l ed before mer s
_day of 20_ by
who is pvsonallyknownto me
orwhohasmoduced as m.
Sigmture of Notary nun
Revised 04/15/16
State.Manda, Countyof St. Lucie County
fet g lnstrumem was ackn Iedg� beforemethis
Jet
of AYI,B'Yd]P' 20., by
NNt r u au
u wfio is twtsonelN
Imown to
um wh ha maaaed am.
II
U21
Signature of Nc ar)
hate
"FY°Oe
'at's,r
ASHLEYHEUER
Commission# NH 079388
e'
N'°or
Excaesdanuaryll,2025
fop
eaMMrhu6aaAe�No�ay5arv4a