HomeMy WebLinkAboutCANCELLATION PF PERMITI
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 SCANNED 4
BY
St Lucie Cnun
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PEWN
PLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR — Chan.
and the new contractor of record for the current pl
contractor information and signature. A new Noti
for job values greater than $2,500 ($7,500 if .
commencing any work. There is a $50.00 fee for
CHANGE OF SUBCONTRACTOR — S
The new subcontractor must fill out a Subcontract
Contrac r.
CANCELLATION OF PERMIT — The c
Cancellation of permit is to be signed and notari.
cancellation of the permit.
Date: '9 ) r
Site Address:
of Contractor is to be signed and notarized by the property owner,
iit. 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 submitted prior to
e Change of Contractor.
contractor 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 work has been done.
by both the owner and qualifier of record. There is no fee for
UY d7
I State License SLC License
Original GC, subcontractor or owner/builder
State License SLC License
New GC, subcontractor
Reason for 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 an and all claims of action for any reason, which may arise as a result of this change of
contractor/subcWtractoro can ation f permit. A perm it cannot be cancelled if work has been performed.
PRINT NAME //,
State of Florida, County of St. Lucie County
The following
1171
day of
Signature of
was acknowledged before me this
20_Z.& bY�TP Y
p_who is personally known to me
SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT
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.
1
Date Signature of Notary
V
Revised 04/15/16
FZM
EYB.HUMPHR
MISSION # FF 174n2
ES; March 6, 2019 Notary Pubrr, Underwriters
D
Date