HomeMy WebLinkAboutREQUEST TO VOID PERMIT PLANNING &DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
COUNT y
2300 VIRGINIA AVE RECENED
FORT PIERCE, FL 34982 FEB 0 2 2022
(772) 462-1553 FAX 462-1578
St-Lucie County
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 PERMT—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:
D D Permit Number:
Site Address:. A) LP 4
A-H_
State License SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor ob
( 1
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
c fees or damages arising from any and all claims of action for any reason,which may arise as a result of this change of
ontr ctor/subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF O R or veer/ u der) J SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME .I C— l—` PRINT NAME
State of Florida,County of St Lucie County State of Florida,County of St.Lucie County
The following irournent was acknowledged efore me this The following instrument was acknowledged before me this
day o e b 2 O,by( / day of 20_ by
W) -1 who is personally known to me who is personally known to
or who hEL
ced as me or who has produced as ID.
Signature of Notary"Date V 0 Signature of Notary Date
Revised 04/15/16 ,o<?neLc; AUDREYB.HUMPHREY
MY COMMISSION#GG?O01c
EXPIRES:March P.
Bonded Thru Notary Put`