HomeMy WebLinkAboutCANCELLATION OF PERMITi
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 signed by the general contractor only.
The new subcontractor must fill out a Subcontractor Agreement Form which is signed by both the contractor and
subcontractor. There is a $50.00 fee for the Change of Sub -Contractor.
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: 0 Permit Number: I J a
Site Address: I 1�-�-� /' c�S� Lot V1 ,Q_
!� 104 lb
A U- /l a G s � � 6J � State Licenseif 6 4EQCqLicense
Original GC, sub tractor or owner/builder
A,7i G d E. Y��� "— State License SLC License
New GC, subcontractor or owner/builder
Reason for Cancellation
The �dersi ed do ere agree to indemnify and hold harmlessStLucieCounty, its officers, agents and employees from all
osgJ
y and all claims ofactionfor anyreason, which may arise as a result of this change of
con / or c , ion of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or owner/builder)
PRINT NAME1(1
(or new GC, as applicable)
State of Florida, County of St Lucie County State of Florida, County of St Lucie County
The following instrument was acknowledged before me this llowing enwledged before
day of Vt � 20 Il by day of t was ackn me this
204 by
who is personally known to me I who is personally known to
"has produced'FL %A9 as ID. me or h r duce Lr as ID.
ro9vfl�1�- r5' g
Signature of Notary Date Signature of Nota D
`""" I<AREN S.
NIELSEN
LASHAHNA INGRAM ���`1PpY. ..
�' _ Commission # FF 115637
<'�:. Notary Public - State o1 Flor, *=
Revised 05/18/2 14 �°= My Commission Expires
My Comm. Expires Dec
i �yrE OF i`OP`,``� June 12, 2018
� � 11��
m, 0j,Commission # FF t'
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