HomeMy WebLinkAboutCancellation Of Permit2017-10-11 12:38 j.a.tayl,- -(oofing 772 468 8397 »y P 1/1
4
........ a PLANNING & DEVELOPMENT SEItVXCE
BIl IL DING & ZONING DIVISION E C E 1 V E
2300 VIRGINIA AVE
• OCT 11 2017
FORT PIERCE, EL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
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 now permit application must also be completed with ;now
contractor information and signature. A new Notice of Commencement must be filed in the now contractor's name
for job values greater than $2,500 .($7,500 if A/C Change -out). rA. 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 Subco><ttractor Agreement Form, There is a $50.00 fee for the Change of Sub-
Contr, ctor.
i' CANCELLATION OF PERNUT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and ztotarizcd by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: es2 L✓. 7 Permit Number: as 5
Site Address: J ��.a c% �141rt h' �� ��. �y' "C', ,� ,r��✓%�
State License bCQ3_358g6LC License _aa
Origi i GC, subcontractor or owner/builder
_.State License SLC Liccnse
New GC, subcontractor
Reason for Cancella04Q�
The undersigned does ht ae;by agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs, Ices or damages arising from any. and all claims of action for any reaso y arise as a result of this change of
contractor/subcontractor or qtmeellation of permit. A permit cannot be l rk has been performed.
SIGNn'1'Ul�ti OP OW�NP,RSI(3NATUt2B GLNERAL CO CTO (or ow GC, as applicable)
PRINT NAME / //G��>71 l/ �'.7C,�SJ� FRIN'1LL
State of Florida, Co»ty of SG Lucie. County State of Florida, County of St, l.uela County
The fol lowing instm-mqt was aftowledged bef re mu this
� day or , 20 -m by Thom A
Th Howl% ios en rulmowlcdSLd h fora a this
�' day or �o (-Z, �rw
_
e h who is ersorudl kno
x Sjrl _..— r
N�
who is Ma Nl know 11111111111//y
` �`>> Mi�/�� Ina or who aaaa ,�ti�Pp�.....
ar wtio h roduocd,( ,`_„a9ID, `�� Q FP i�
�13910ry`.'�
• ri �P
lS,�oA -'
V$kgnnturc
�p -.�c� hot 1 ��`•
$�,°r��
of Notary Date X aecc�or
$
signa�tary
Date Sao`
S
~' ~
OFF 936050 �,�a
Roviuod 04/15/16 r25�••�a`:
OFF 936050 = t
,,� •,,{{��
hg;;'.•��d@•�
,�/�NotoH.O�Q``,$
il 11 f 1111� 1��`\