HomeMy WebLinkAboutRequest to void letter PLANNING
& DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
„ 2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 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 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: Permit Number: ZCV 1-0 YOO
Site Address: 3 31 0,C e
State Licensees 1333) Z Y SLC License
Original GC, subcontractor or owner/builder
State License SLC License
New GC,subcontractor
i
Reason for Cancellation W 0e,7—
The undersigned does hereby agree to indemnify and hold harmless St Lucie County,i 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/subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed,
Xproduced
OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
���� PR.INTNANE �k.0 C9
a,Co f St Lucie County State of Florida,County of St.Lucie County GY o c
cat a�
ins en was acknowledged before me this ollowin w ent was acknowledged b ore me this
f 20 by day UT a 2�jby��who is personally known to me who is personally known to cc Waoduced as ID. me o ho h produ ID.
Signature of Notary Date Signature of No Date
Revised 04/15/16 �J tpP Nrip•, AUDRE" i rPHREY
tiI .'pPya AUDREYB.HUMPhIREY ') °• ° MYCOmp,; ,;,t`i1?iGG300817
I MY COMMISSION i GG 300.'!? ` +? 2023
EXP.
EXPIRES:March 6,2023
I .•.'�?P c For 6yQ Bonded T r:.irr�Puh_ c U7°ters ��
Bonded Thru Notary Public Undervrdt