HomeMy WebLinkAboutCANCELLATION OF PERMITr
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION SCANNED
2300 VIRGINIA AVE
BY
FORT PIERCE, FL 34982 at Lucie C®u*
(772) 462'LI553 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 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.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
C cellation 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: Permit Number: (9%dt7*1
Site Address: I Q -S• lr► c.Q , oki! r be,
-A i-�eMQ L elrgfi ,�*fState License —a 1,3(V,§'lS7QLC License
Original GC, subcontractor or ownerlbuilder
New GC, subcontractor
Reason for Cancellation
License SLC License
1W�/\� tl- ` Qv
The undersigned does hereby agree to indemnify andi 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, C Celle if w rk has been performed.
SIGNATURE.OF OWNER (or owner/builder) SIdN<TURE GEN
ERA
%L CONTRACT (or new GC,, as applicable)
Vim. PRINT NAME PRINT NAME f c > 0 J en (Je a
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_ by
is personally known to me
or who has produced as ID.
Signature of Notary Date
Revised 04/15/16
State of Florida, County of St. Lucie County
The ollowing i ent was ackngj4 edged before me this
t day
`off 20 _/zfby
CT�i1R�D�Rr�u�ho' its personally known to
F. or who has produced '1�A as ID.
Signature of Notary Date
•,u� u,, . LASHAHNA INGRAM
Yru;`c'; Notary Public - State of Florida
• My Comm. Expires Dec 20, 2018
iN.`�„1111, 4fP,Z Commission # FF 177249
Bonded through National Notary Assn. '