HomeMy WebLinkAboutCancellation Of Permit04/12/2018 11:37 FAX 7724606929
WILCO
0 002
4/10/2018
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Development Services
S ! 1 =
DuAding & Code Regulations Division
c •:
2300 Virginia Ave.
Fort Pierce, M 349M
(ra)462-1553 Fax 462-108
C UNGE OF CONTRACTOR
Or Sabcoetracbor or Can=liation of Permit
Change of Conn -actor is to be completed by the property owner, and the nedy contractor of record for the
current permit. A new permit application MA also be completed with new contractor information,
signature, and transfer fee. A new Notice of Conlweneemlent must be filed in the neW contractor's
name for job values greater than $2,500 ($7,504 if A/C Change -out). A recorded copy mmt be
submitted prior to commencing any work. Subcontractor changes can bt: coinpleted by the general
contractor. Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: a�srto+s
permit \umber; 170e-017
Site Address: tossi S. oat -AN DR LCr 133, JENSEN BEACH, FL 34W
VVILCO coNSTRuCTION INN MaERr WILIAMS State License SG,. • 3'. 's' =5 SLC Lice = 29115
original (or Subcontractor)
--._—_State Lieeoae _.... SLC License_,
Nevr General Contra_ctor (ar Sabcontmvtor)
IteMn• fb Chaogo, QM MROECMQTO1=FAVrz;%- iK0=9QNrJtl. K'Qk =pffoa
The' undersigned does hereby agree to indemKv and hold. harmless St. Lucie Count", its officers,
agents, and employees from all COSts, fees, or damages arlsin$ ft'om any and all Claims of action for
any rased, which may arise as a Msult of this change of contrAMV$ubt ontr.►a0f or caticenatior or
pnrnzk A Qe it.cannot been celled ifwork bar been performed.
s[ ATME C?F O (or � SFGNATtME OF NEW GMIF.RAL CON fR,i MR
MAT b1MY [a�lt¢�r .!��5�sc,��? FRmr�rA,rte RQBf;�R-f 1MlL. LAMS
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Date
*Only slgliature required fob change of vabcontzactor
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