HomeMy WebLinkAboutCANCELLATION OF PERMIT PLANNING &DEVELOPMENT SERVICES
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BUILDING& ZONING DIVISION RECEIVED
0 P —
2300 VIRGINIA AVE JAN 0 7 2022
- - FORT PIERCE, FL 34982 St.Lucie County
(772) 462-1553 FAX 462-1578 Permitting
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 subcontractor must 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: 2-0 _2�Z Permit Number: 2 I t 2 - 2
Site Address: z 5 J NC A,"rc SO 9/von i �Q�f f7'_ ii✓CdC , C—L 3Vl9
Oho a q _2 O c-s-F"n u , c o, State License CC C]33zf f( SLC License f�f
OriginaltC,subcontract or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation CAMP n 4- IC4,'/e Ci �p dQ�
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
contract/or/s�ubconntractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
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SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME ,4 r TVfo 2 eV n0.To PRINTNAME
State of Florida,County of St.Lucie County State of Florida,County of St.Lucie County
The following instrument was acknowledged before me this The following instrument was acknowledged before me this
day of 3a-- 20 aX by A t t'y d y day of 20_,by
kt!s,e.c>'S a who is personally known to me who is personally known to
r e�who has produced Fc L l- as ID. me or who has produced as ID.
Signature of Notary Date Signature of Notary Date
=-.' ,
DEANNA GIVENSPublic•State of Florida
Revisedission#HH 086359
m.Expires Jan 28,2025gh National Notary Assn.
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