HomeMy WebLinkAbout2135 pert cancelPLANNING & 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 $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subconhactor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Cont actor.
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:
1/19122
Site Address: x 2135 Nettles Blvd
Law' Electrical Service Inc
Original GC, subcontractor or owner/builder
NONE
New GC, subcontractor
Permit Number: 2201-0354
License EC 13006370 SLC License 29432
License SLC License
Reason for Cancellation owner decided not to spend the money
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 action for any reason, which may arise as a result of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be ca Iled ' work has be�med.
SIGNATURE OF OWNER (orowner/builder) SIGN RE GENERAL CONTRACTOR(or new GC as applicable)
PRINT NAME PRINT NAME
Slate of Florida, County of Sl. Lucie County
The following instrument was acknowledged before me this
_day of ,20_, by
who is personally known to me
or who has produced xs ID.
1119/22
Stgnsfure of Naha y Date
Revised 04/15/16
Stateof Florida,C(Amlyof Sl Lucie County
The following lost merit was aclmo ledge fore melthiis
day of i 20 . b
who is personally known to
me or,7 has Pi)xhreted as ID.
,l-� �( ifJ , 1/19/22
Signotureof Nolary Date
DAWN FITZGERALD
MYCOMMMION11HH187455
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