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HomeMy WebLinkAboutCANCEL -REQUEST TO VOID PERMITPLANNING & DEVELOPMENT SERVICES �q VP BUILDING & ZONING DIVISION R '� 2300 VIRGINIA AVE F8 ` �fLs�,q/ FORT PIERCE, FL 34982 st �. o ZO? (772) 462-1553 FAX 462-1578 pe �MeC CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT PLEASE SELECT ONE OF THE FOLLOWING: 5�%(50o,& - �(/� 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 - Contra tor. 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: 2,5 — 2 Z Site Address:. 96 S �F La4l ►'_ Original GC, subcontractor or owner/builder New GC, subcontractor Reason for Cancellation _ _ 5 © � � 6 T Permit Number: ?,,) / 2— 62 S % License C /-7SSeyo0 SLC License License SLC License IN le ( (10 q C C, /r t The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all cosNfees or damages arising from any and all claims of action for any reason, which may arise as a result of this change of contrabtor/subcontractor or cancellation of perr6it. A permit cannot be cancelled if work has been performed. SIGNATURE OF O R (or o r/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable) PRINT NAME �-03 J 11 c State of Florida'County of St. Lucie County The fo mg instrument was acknowledged before me this day of 20_, by__�_ who is personally known to me or who has produced as ID. PRINT NAMELqr ) w( t l I Qfl" S State of Florida, County of St. Lucie County The f 1lowhig ' trument was acknowledge before m tl day of 20 y� wl�� me or is personally known to _-ds ID. Signature of Notary Date . °s p�'% g rY Signature of Nota a °.: E State f,,J VgUG ,1F�ommiss or a Notary Pub) nu��`` Revised 04/15/16 YOcto & 'On n xp-