HomeMy WebLinkAboutCancel letter PLANNING.& DEVELOPMENT SERVICE,
BUILDING& ZONING DIVISION ��-Z
COUNTY 2300 VIRGINIA AVE 0210�
FORT PIERCE, FL 34982Nor-"
(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 properly 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.
ancellation 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: a l 2—/ Z Z Permit Number: /o l c d
Site Address: . Y o
�)yy,.(d F,✓ State License SLC License
Original GC, subcontractor or owner/builder
State License SLC License
New GC,subcontractor I n
Reason for Cancellation
�s� ��� �IJ h(�� 5�'"P) /6,11o'�l C�cofli� QS �'� luu5
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 P.
contract su contracrt�or o lation of permit.A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATURE GENERAL CONTRACTOR(or new GC,as applicable)
PRINT NAME nn�� C�, EA PRINTNAME
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 following instrument was acknowledged before me this
']i day of 20_2�aby t0K\_&6 day of 20_,by
who is personally known to me who is personally known to
or who has produced_ �as ID. me or who has produced as ID.
Signature f��tgpy,, E L LP VA U G H N Signature of Notary Date
a° `_State of Florida-Notary Public
Commission # GG 270079
My Commission-Expires
Revised 4n Octobor 22, 2022