HomeMy WebLinkAbout request to void permit - PLANNING & DEVELOPMENT SERVICES RECEivEo
BUILDING & ZONING DIVISION VEB 0 2 202�
® 2300 VIRGINIA AVE
- - - - FORT PIERCE, FL 34982.
(772) 4624553 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 subcontractor must fill out a Subcontractor Agreement Form. There is a$50.00 fee for the Change of Sub-
Contractor.
CANCELLATION OF PERART—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: 1/13/2022 Permit Number: 2103-0377
Site Address' 5709 Eastwood Drive
DOYLE,MOREY CHRISTOPHER State License CGC1517458 SLC License
Original GC, subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation This is a lot that is not buildable.
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/s t cent or cancellation of permit.A permit cannot be cancelled if o has een performed.
SIGNATURE OFOWNER(or otivner/builder) SIGNATURE GENERAL C CTO (or new GC,as applicable)
PRINT NAME '�+�rey Do p�N� MOr Doyle
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
13th day of January 20�by Morey ,sm �y of January 20�?�key Morey
Doyle who is personally known to me Doyle who is personally known to
or who has produced as ID. me or who has produced_ ID
1/13/2022 / Qon., _�1/13/2022
Signature of Notary Date Signature of Notary Date
Notary Public State of Florida Notary Public State of Florida
Revised 0 4/ / Heather C Dahlin Heather C Dahlin
My Commission HH 029010 My Commission HH 029010
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