HomeMy WebLinkAboutCANCELLATION OF PERMITPLANNIN,
BUILDIN(
2300 VIRC
FORT PIE
(772) 462-1
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Change
and the new contractor of record for the current perr
contractor information and signature. A new Notice
for job values greater than $2,500 ($7,500 if A/
commencing any work. There is a $50.00 fee for th
CHANGE OF SUBCONTRACTOR — Sub
The new subcontractor must fill out a Subcontractor.
Contractor.
)( —CANCELLATION OF PERMIT — The car
Cancellation of permit is to be signed and notarizec
cancellationof the permit.
& DEVELOPMENT
& ZONING DIVISIO
NIA AVE
.CE, FL 3.4982
53. FAX 462-1.578
JUL 17 2018
Permitting Department
St. Lucre County, FL
Df Contractor is to be signed and notarized by Ithe property owner,
it. A new permit application must also be completed with new
of Commencement must be filed in the new contractor's name
Change -out). A recorded copy must be I submitted prior to
Change of Contractor.
,ontractor changes are to be completed by the general contractor.
Agreement Form. There is a $50.00 fee for the Change of Sub-
ellation of a permit is acceptable only if no kyork has been done.
by both the owner and qualifier of record. There is no fee for
Date: 7/13/2018 I
Permit Number: 1804-0367
I
Site Address: 804 SHORE WINDS DR - BLD C, FORT PIERCE
J.A. TAYLOR ROOFING INC - KYLE WHITE
State License CCC 1325895 SLC License
23018
Original GC, subcontractor or owner/builder
State License SLC License
I
New GC, subcontractor
Reason for Cancellation OWNER REQUESTED OANCELLATION
The undersigned does hereby agree to indemnify and hold harmless
St Lucie County, its of tcers, agents and employees from all
costs, fees or damages arising from any and all claims of act)on
for any reason; whi y se as a result of this change of
contractor/subcontractor or cancellation of permit. A permit
cannot a if wor s been performed.
SIGNATURE OF OWNER (orowner/builder)
SIGNATURE GENERAL CONTRACTOR (or new GC, aslapplicabie)
PRINT NAME
PRINTNAME KYLE WHITE.
State of Florida, County of St. Lucie County
I
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this,
a ollnstE owing i1m nt gas acledged before me this,
day ��`��r
day of 2'0_ by
of - 20 by a° fi��•d �155 •
who is personally known'to me
who is personally known to
or who has produced as ID.
me or w has ced as In.
Signature of Notary Date
�gnature of Notary Date lryf'-iIGN z, ,=r4ti
11I i 1 1�wN
Revised 04/15/16