HomeMy WebLinkAboutPOTTER CANCELATION PERMITCOUNTY
F E O R l o A
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DMSION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR,SUBC N RA TOR OR CANCELLATION OF PERMT
PLEASg SELECT ONg OF THE FOLLOW G.-
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 ,fob 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 $50.00 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 $50.00 fee for the Change of Sub -
Contractor.
ra' a CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has bet n done.
Cancellation of permit is to be signed and notarized by both the owner and qualifier of record. Where is no fee for
cancellation of the permit.
Date: 1118/2022
Site Address: 1813 NW BUTfONBUSH CIR
Permit Number: 160"059
ACCURATE ELECTRICAL CONTRACTING, INC State License EC0903072 SLC License 18629
Original GC, subcontractor or owner/builder
State License SLC License
New GC, subcontractor
Reason for Cancellation COVERED UNDER MASTER PERMIT #1507-0139
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, fees damagt s art g from any and all claims of action for any reason, which may arise as a result of this change of
contractg> ubcontra B) r cancellation ofpermit. A permit cannot be cancelled if work has been performed.
SIGiV`/ TDkE OF Aw R (or ownerlbuilder) SIGNATURE. GENERALCONTRACTOR (or new GC, as applicable)
PRINT NAME �i�'%/IJP� fA'(;a IA-AW PRINTNAME
State of Florida, County of& Lucie County State of Florida, Countyof St. Lucie County
The fAuiving instrument was acknowledged before me this
�h t
. day of . i lc r4 , 201 , by-. _.. _. .
u is vuall�kuvwn to rit
o who has produced as TD.
1118/2022
8 grrature of notary Date
f,: < 3ESSICASANC4IEZ
Revised 04/15/16 CotlttAiu" #N"881W
os E*"1a2W
'.,,a+,!;Y�;� 0or�edThNTroklF�ttY►iutrla8D0+'t6�7019
The following instrument was acknowledged before me this
day of , 20by
wbo is personally known to
me or who has produced as 1D.
1 /1812022
Signature of Notary Date