HomeMy WebLinkAbout REQUEST TO VOID PLANNING&DEVELOPMENT SERVICTSCEIVED
BUILDING ZONING DIVISION
COONTY 2300 VIRGIIA AVE FEB 0 8 2022
FORT PE RCE,FL 34982 St.Lucie County
(772)4624553 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-t • 2 " :too`� Permit Number:
. _
Site Address: 9_Z
State License SLC License
Original GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,its officers,agents and employees from all
costs or damages arising from y and all claims of action for any reason,which may arise as a result of this change of
tractor/ubronttrractor or ancel on of permit.A permit cannot he cancelled if work has been performed.
Sor /b ' er) SIGNATURE GENERALCONTRACTOR(or new GC,as applicable)
IVT NAME -V Lf� PRINTNAMS
State ofFkorida,County of St Lucie County State of Florida,County of St LucieCounty
Tic following instrument was acknowledged before mo is The following 4mtrurnent was acknowledged before me this
O day of 20,Ic0-,by (�lll day of -20 by
who is personally known to me who is personally known to
f—
ortl�bproduc as�. me or who has producedas ID.
Sof No ty Date signature of Notary Date
VARINIA DENNES
Revised 04/15/16 Notary public
o State of Florida
' Comm#HH166622
Expires 8/18/2025
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