HomeMy WebLinkAboutCancellation Of Permit 3-30-22i
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION RECEWb
230ft VTRGTNTA AVE
FORT PIERCE, FL 34982
3 0 202?
772 462-1553 FAX 462-1578 � ' Lean U010'fin"g"
Permitting
PLEASE SELECT ONE OF THE FOLLOWING: j
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.
i
—CANCELLATION OF PERNUT — 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 andi qualifier of (record. There is no fee for
cancellation of the permit.
Date: g Permit Number:
Site Address: 91 cf, f✓ , d;o��
icense
Original GC, subcontractor or owner/builder
State License
New GC, subcontractor / n /%
Reason for Cancellation A V /V In Ue �
The undersigned does hereby agree to. indemnify and hold harmless St Lucie County
costs, fees or damages arising from any and all claims of action for any reason, whic]
con ctor/subcontractor o cancellation of it. A permit cannot be cancelled if
SIGNATURE OF R or owner/builder) SIGNATURE GENERAL
PRINT NAME S%r, 1_� C�e PRINT NAME
State of Florida, County of St Lucie County
The following instrument was acknowledged before me this
'k�-b day of Ma. t 120 by t t as t c,
1 nqS c.c. who is personally known to me
or who has produced as ID.
NNA GIVENS Dote 1
r du aA State of Florida 1
Notary Public
_�� a Commission = F{H 086351
an 28.p25
ExPires J
Z 04Y65r National Notary Assn,
Bonded througF�
License
License
its officers, agents and employees from all
may arise as !a result of this change of
vork has been performed.
new GC, as applicable)
State of Florida, County of St. Lucie Countyi
The following instrument was acknowledged before me this
day of 20_, by
who is personally known to
me or who has produced as W.
Signature of Notary I Date