HomeMy WebLinkAboutCANCELLATION OF PERMITWANNEDD
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PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVERieut
FORT PIERCE, FL 34982 E�
(772) 462-1553 FAX 462-1578 JUL 1 7
E
Z018
'TOR SUBCONTRACTOR OR CANCELLATIONiV%VVngC. Departm1
j Cle COunty, F
PLEASE SELECT ONE OF THE FOLLOWING: j
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 Changed of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractori changes are to be completed by the general contractor.
The new subcontractor must fill out a&bcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
Contractor.
_CANCELLATION OF PERMIT — The cancellation If 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.
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Date: 7/13/2018 Permit Number: 1804— 3ss
Site Address: 804 SHORE WINDS DR - BLD B, FORT PIERCE .
J.A. TAYLOR ROOFING INC - KYLE WHITE State Liclense CCC 1325895 SLC License 23018
Original GC, subcontractor or owner/builder
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State License SLC License
New GC, subcontractor
Reason for Cancellation OWNER REQUESTED CANCELLATION
The undersigned does hereby agree to indemnify and 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 s a result -of this change of
contractor/subcontractor or cancellation of permit. A permit cannot be cancelled ieen performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GENERAI, CONTRACTOR (or new GC, as applicable)
PRINT NAME
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
IIRINTNAME KYLE WHITE
State of Florida, County of St. Lucie County
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11re oolowing instrum t rs ack{{ vlcdged before me this
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20 by
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iayho is personally known to;;;
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' OFF 936050
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