HomeMy WebLinkAboutCancellation of Permit RequestPLANNING & 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: all �1 Permit Number: o;t 10 I3 SS'- OS Sf,
Site Address: R01'J CCf 1 kVr% �U�fi StL, de FL 8'j,"I 7
State License SLC License
Original GC, subcontractor or os er/builde
State License SLC License
New GC, subcontractor
Reason for Cancellation DeccdJ vto-1' ►-f: p,,/t VP eifr isL
The undersigned does hereby agree to indemnify and hold harmless Si Lucie Counts. its officers. agents and cmployecs from all
costs, fees or damagesAming from arty and alhclaims of action for any reason, which may arise as a result of this change of
co►arWWr/stAbcom(ec,ar cancellaticUDL;iedniLA permit cannot be cancelled if work has been performed.
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State of Florida, County of St. Lucie County
The following rostrum t was ardmowkedged before me this
aLday of—L. 20ta by
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Signature of Notary Dare
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SIGNATURE GENERAL CONIRAC'IOR (or new (iC, as applicable)
State of Florida, County of St. Lucie County,
"The following instrument was acknowledged before me this
day of .20_by
who is personally known to
me or who has produced as ID.
Signature of Notary Dare