HomeMy WebLinkAboutCANCELLATION OF PERMITSCANNED
By
PLANNINGLY E ��i4PMENT S
fill, BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR - C
and the new contractor of record for the currei
contractor information and signature. A new 1.
for job values greater than $2,500 ($7,500
commencing any work. There is a $50.00 fee
i - 1 CHANGE OF SUBCONTRACTOR
The new subcontractor must fill out a Subconi
Contractor.
✓ i CANCELLATION OF PERMIT -'I
Cancellation of permit is to be signed and no
cancellation of the permit.
Date: 1" J _Q /zs
Site Address:
EIVED
NOV 15 2018
Permitting 'Department
St. Lucie County, FL
tnge of Contractor is to be signed and notarized by the property owner,
permit. A new permit application must also be completed with new
)tice of Commencement must be filed in the new contractor's name
' A/C Change -out). A recorded copy must be submitted prior to
tr the Change of Contractor.
Subcontractor changes are to be completed by the general contractor.
ctor Agreement Form. There is a $50.00 fee for the Change of Sub -
cancellation of a permit is acceptable only if no work has been done.
[zed by both the owner and qualifier of record. There is no fee for
-____ ._- _,
Permit Number: !SLC 1. d-6 3 -- 0 026-'
Own _a IPA. --- _ --- ----- _ E State License; ti'h SLC License
Original GC, subcontractor or owner/builder
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify a
costs, fees or damages ap§ing from any and all cla
contractor ubcontractpr or cancellation of permit.
License .__ ___. __ _ .___._ ____ 'SLC License
PA
hold harmless St Lucie County, its officers, agents and employees from all
0 of action for any reason, which may arise as a result of this change of
ep rmit cannot be cancelled if work has been performed.
SIGN RE OF 6#NER (or ownertbuilder)
?o ,,
SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
RINT
PRINT NAME
State of Florida, County of St. Lucie County
z _s Q
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
o ccnn. � Q
The following instrument acknowledged before me this
LE(or da of { 0 v -
day 20�
s
_was
day of + , 20� by f
_by,:o
tH L 0�1 t?�1 o ho s piers Nally known to
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Ito is personally known to
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or who has produced s IU' -
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me or who has produced i as-iD.
Signature of No Date
H
Signature of Notary Date
Revised 04/15/16
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