HomeMy WebLinkAboutCANCELLATION OF PERMIT_ PLANNING & 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.
is 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: 3/10/2022
Permit Number: SLC 2108-0444
Site Address: 1691 TIMBERLAKE DR FORT PIERCE FL 34947
License 1330489 SLC License
Original GC, subcontractor or owner/builder
License SLC License
New GC, subcontractor
Reason for Cancellation No Job has been done
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 b n performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAL CO ACTOR (or new GC, as applicable)
PRINT NAME
State of Florida, County of St. Lucie Cowry
The following instrument was acknowledged before me this
day of 20J by
or who has produced_
Signature of Notary
Revised 04/15/16
personally known to me
rs ID.
Date
PRINTNAME Robert Donovan
State of Florida, County of St. Lucie County
following insmom, was acknowledged before me this
dey of , 20,Wby
is personatly (mown to
me or who Jas produced_as ID.
a121,
Signature of Notary Date
Notary Publlo Stete of Florloa
Judith Duran
IIII MyNM° o76Spion
EXp. t t/17/2025