HomeMy WebLinkAboutCANCELATION OF PERMIT�°� � p �•� l ems,
SCANN `
PLANNING & DEVELOPMENT &
BUILDING & ZONING DIVISION
2300 VIRI
FORT PI1
(772)462-
E OF
PLEASE SELECT ONE OF THE FOLLOWING:
INIA AVE
FL 34982
FAX 462-1578
M
JUL 17 2018.
Permitting Department
St. Lucie County, FL
CHANGE OF CONTRACTOR — Chan e of Contractor is to be signed and notarized by the property owner,
and the new contractor of record for the current pe mit. 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 ($1,500 if t�/C Change -out). A recorded copy must be submitted prior to
commencing any work. There is a $50.00 fee, for he Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out' a Subcontract¢¢r Agreement Form. There is a $50.06 fee for the Change of Sub-
nrtractor,
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 notariz d by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 7/13/2018 Permit Number: 'a. °,�
Site Address: 804 SHORE WINDS DR - BLD A, FORT PIERCE
J.A. TAYLOR ROOFING INC - KYLE WHITE State License CCC 1325895 SLC License 23018
Original GC, subcontractor or owner/builder
I State License SLC License
New GC, subcontractor
Reason for Cancellation OWNER REQUESTED CANCELLATION
The undersigned does hereby agree to indemnify and.
costs, fees or damages arising from any and all claims
contractor/subcontractor or cancellation of permit. A I
SIGNATURE OF OWNER (or owner/builder)
PRINT
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20_, by
who is personally known to me
or who has produced as ID.
Signature of Notary bate
Revised 04/15/16
d harmless St Lucie County, its officers, agents and employees from all
action for any reason, which r' a as a result of this change of
•mit cannot be cane work s been performed.
SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINTNAME KYLEWHITE
State of Florida, County of St. Lucie County �tiA�ttiitillllfli,�;sir
The following instrume t s ackn��1`ledgedbefore me this Lt� \plc M/iry 6 y,
14�F
20 by
who is personally known to � „-� �� R�` •,��, 9 -
me duced as ID.
9.160-0
ignature of Notary DUR