HomeMy WebLinkAboutPermit Cancellation FormPLANNING & DEVELOPMENT SERVICES
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERNIT
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.
.47088- CANCELLATION OF PERNHT — 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: 2/15/22 Permit Number: 2201-0064
Site Address: x4708 Sunset Blvd. Fort Pierce 34982
Gary Germanton State License EC13010020 SLC License
Original GC, subcontractor or owner/builder
State License SLC License
New GC, subcontractor
Reason for Cancellation No work performed/Customer cancelled contract
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 reaso which may arise as a, yesult of this change of
contractor/subcontractor or cancellation of permit. A permit cannot b 'ca lied if wok hasfib7nperfor�ied.
SIGNATURE OF OWNER (or owner/builder) GNATUR GE RAVACONTRACT (or new , as applicable)
PRINT NAME PRINTNAME Gary Germanto
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this e g i� iment was acknowledged before me this
day of 20_, by > day of� - 20"Z by
:�S
who is personally known to me who is personally known to
or who has produced 2/15/2 eo prod ed 2/15/ID. \\\22
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Signature of Notary Date Signature o tary Date ��\ f 1`iCi'
Expires 6))
Revised 04/15/16 N�Dennis R GodseyQ`
;7 My Commission
HH 197497
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