HomeMy WebLinkAbout4544 Davidson permit cancelation form - signedState of Florida Department of Economic Opportunity Rebuild Florida Program Permit / 4R 1463
PLANNING & 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 must be submitted prior to
commencing any work There is a S50.00 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 S50.00 fee for the Change of Sub-
Aance
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The cancellation of a permit is acceptable only if no work has been done.
a ion o permiotarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 1114122
Site Address: 7302 Pacific Ave Ft Pierce, FL 34951
Permit Number: SLC 2105,0520
Patriot Response Group 1 James Foster Qualifier State License CGC-1526178 SLC License 32017
Original GC, subcontractor or owner/builder
State License SLC License
New GC subcontractor
Rebuild Florida Program permit - homeowner damaged his carport support making work unsafe according to the Program. We have been waiting for the
Reason for Cancellation homeowner o correct the supped Issue before we can start work. Homeowner has notfaken tare of it and we now need to cancel dhe pennR.
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 and all claims of action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancelI on of pe it. A permit cannot be cancelled if work has been performed.
X.
IGNATURE OF OWNER or er/builder
i ) SIGNAT - GENIiR L C(}NTRAC71'0R (or new GC, as applicable)
PRINT NAME_�JC % rJBtOv PRINT NAME James Foster
State of Florida, County of St Lucie County
The following instrument was acknowled me this
t 4th day of January , 20_=,
who is personally known to me
or mh as duce as ID.
1/14/22
Signahrrc o otary Date
Revis ��tp4�ik16 No1ary Public; state of Fknrda
Vince ♦i Olvey
My Cammisa+on HH 037633
%2 W Expres 00,3012024
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
141h day of—.:!!— , 20-!!— by Jmw -ts,
who is personally known to
m or who has produce as lb.
llIZ22
Signatureof)\otary Date
CAROL A PORTAL
Notary Public State of Florida
Commission # GG 339233
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My Comm. Expires 05-28-2023
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