HomeMy WebLinkAboutcancellation noticecouNTy.FtOEIDft
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DTWSION
23OO VIRGIIYIA A\rE
FORT PrERCE,FL34982
(772) 462-1553 FAX 462-1578
CHA]\GE OF CONTRACTOR. SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLQWING:
CHANGE OF CONTRACTOR - Change of Contactor is to be signed and notarized by the properly owner,
anAtlenewcontractorofrecordforthe current permit. A new perrnit application must also be cornpleted with new
contactor information and signature. A new Notice of Commencernent must be filed in the new contractor's name
for job values greater then $2,500 ($7,500 if A/C Change-out). A recorded copy must be submitted prior to
commencing any work. Ihere is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCOIT{TRACTOR - Subconfi:actor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
Contractor.
V CaNCELLATION OF PERIVIIT-The cancellation of apermit is acceptable only if no workhas been done.
Cincellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit
Date:t$'7.2 Permit Number:2lt:j -cll99
Site Address:{c /U'\ 4U *7 l1y{ff Fc
State License-SlC License
Qfq+c License-SlC License-
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnif, 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 been performed.
OF SICNATURE GENERAL CONTRACTOR (ornew GC, as applicable)
PRINT NAME PRINTNAME
ilall tt:<'t- L,f /4/+l; t 14 L t Df 7/\ J FA,ift,?
State of Florida, County of SLl.rrcie€eua$
rhe fouowing inr*-*r *FSflF*i'r4SY.ff.. .",i 1,
,B. auv or lsr.-h-, zo?L, by Eyjr,xrJ-
who is personally known to me
State of Florida, County of St. Lucie County
The lbllowing instrument was acknowledged before me this
_day of _. l0_ .
is personally known to
me or who hasor who has
;x:Notary Public State of Florida
JeremY Matthew Malvan
My Commtssron GG 304020
Exprcs 02t2012O23
Revised 04/\5/LG
Dste
ID.
Signature of Notrry Date
ID.
I