HomeMy WebLinkAboutCancellation of Permit `
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PLANNING & DEVELOPMENT SERVICES RECEIVED
BUILDING & ZONING DIVISION
• 2300 VIRGINIA AVE MAR 0 9 2022
• P
FORT PIERCE, FL 34982 St.Lucie County
(772) 462-1553 FAX 462-1578 Permittil g
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.
ancellation of permit is to be signed and notarized by both the owner and qualifier of record. Thereiis no fee for
cancellation of the permit.
Date: J I Z"?_ Permit Number: 0?4009 005-00
Site Address: O
State License License
OrOnal GC,subcontractor or owner/builder
State License SLC License
New GC,subcontractor
Reason for Cancellation �Q�
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 can t be cancelled if ork has beep performed.
SIGNATURE OF OWNER(or owner/builder) SIGNATU C 1 I`cab
PRINT NAME PRINT NAME `�
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 inst men was ackn wledge before met is
day of 20 by day of aa& 20 by q
who is personally known to me who is p to
or who has produced as D. me or who has produced as ID.
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Signature of Notary Date Signature of Notary Date
Revised 04/15/16
E,;:14%�tP Notary Public State of Florida
Bunnie Merntt Woodard
nny Comm.ssion HH 039826
Expires 09/07/2024
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After receipt of permit,the church members took it upon themselves to do the cement work. Upon
discovery we called in a footing inspection. The inspection failed. We informed the church that lit was
to be removed and that we do our own work. Instead of removing footer they proceeded to pour a
concrete slab. As we did not do the work,the church has voided our contract. We will not do any work
on this project.We gave them more than ample time to resolve this issue. Since this was a beach of
contract,we would like to cancel permit#2008-0058.
RECEIVED
MAR 0 9 2022
St.Lucie County
Permitting
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