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HomeMy WebLinkAboutcancelation fo subs PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION COUNTY 2300 VIRGINIA AVE Bu uuo FORT PIERCE, FL 34982 tiunoo o1ani,is (772) 462-1553 FAX 462-1578 Noz 8 1 83J C13AI303U 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 commenc. g 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: a Q7 p� Site Address: 1 qr (2 ntz� 6 ax t<1,5 _ ra,4, t1 Iry State License SLC License K7___Z!1 Original ow subcontractor )or owner/builder N/<!�K5 f (� +aI h,� State License SLC License New GC, subcontractor f Reason for Cancellation �v/�`j� (�a ��'� © j o) 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/subcontractor or cancellation of permit.A permit cannot be cancelled if work has been performed. SIGNATURE OF OWNER(or owner/builder) SIGNATURE GE14TRAL CONTRACTOR(or new GC,as applicable) PRINT NAME PRINT NAME �r/i.W�' F, 5,4k+Av 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 ollowing ins ent was acknowledged.J2efore me this day of 20_by day of _ 2�3.11y n who is personally known to me who is personally known to or who has produced as ID. me or who has producedELas ID C./ Signature of Notary Date Signa OF _state of 1`10089tNotary Public Commission # GG 270079 a My Commission Expires I OF R� /llllll Getober 221 2022 Revised 04/15/16 — PLANNING & DEVELOPMENT SERVICES BUILDING & ZONING DIVISION 2300 VIRGINIA AVE + FORT PIERCE FL 34982 QU1QWJ8d (772) 462-1553 FAX 462-1578 A4unop eionj-IS ZZOZ 8 18�� CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OLL T 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 commenc. g 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 PERNUT—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: Site Address: ! —t n fn �b (a ) La K_f;_L5 State License SLC License Z131% Original GC, subcontractor or owner/builder A� State License SLC License New GC,subcontractor Reason for Cancellation A fl� O l 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/subcontractor or cancellation of permit.A permit cannot be cancelled if work has been perfo med. a SIGNATURE OF OWNER(or owner/builder) SIGNATURE GEktRAL CONTRACTOR(or new GC,as applicable) PRINT NAME PRINTNAME -.!L460' F, 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 oolowing ins ment was acknowledged before me this day of 20_,by day of who is personally known to me who is personally known to or who has produced as ID. me or who has produced L D Las ID v Ube Signature of Notary Date signat ff State of Flo P-Notary Public Commission # GG 270079 My Commission Expires _ Oetebbr 22 B9ga Revised 04/15/16 -