HomeMy WebLinkAboutCANCELLATION OF PERMITPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE RECEIVED
FORT PIERCE, FL 34982 MAR 2 . S 2022
(772) 462-1553 FAX 462-1578 St. Lucie County
Permitting
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 copyust be submitted prior to
commencing any work. There is a $50.00 fee for the Change of Contractor. 1.
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-
C ntractor.
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 Dermit.
Date: i��V
Site Address: —?/5 s
Original GC, subcontractor or owner/builder
Permit Number: c/00 —000,5
State License
License
State License SL;C License
New GC, subcontractor
Reason for Cancellation
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, whichl,may arise as a+result of this change of
contr ct r/sMTractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
I J
SIGN WNER (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
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PRINT NAME �,L�tn d2r� PRINT NAME
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
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or who has
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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 Date