HomeMy WebLinkAboutCANCELATION OF PERMITPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
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.:.CEIVEC -
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ci<, C,,xinty, Permitting
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
PLEASE SELECT ONE OF THE FOLLOWING:
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 Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor.
The new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
Contr ctor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
C/ricel ation 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.
Date: S- 2 L 19
Permit Number: 31(3(o — d 5 S
Site Address: ZJ5 ,Aryl in/. ' 4cu, A o
o�,WdA State License L' C C SLC License
Original GC, subcontractor or owner/builder
9ri1 n/ State LicenseCC C 1.336Y SLC License
New GC, subco tractor
Reason for Cancellattbn
The uWfee/esn
agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from all
costs,g from any and all claims of action for any reason, which may arise as a result of this change of
contrancell tion of permit. A permit cannot be cancelled if work has been performed.
SIG ZF O (or er/buil1deer) II II SIGNATURE GENERAL CONTRA,,,,C,1T/�O, R (or new G1 C, as applicable)
P T �I m � PRINT NAME�f-V 1PY�� I�GLVod'
nc $t' oe ,
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
ji-kay
wing i strument was acknowledged before me this a following in ent was acknowledged before a this
of 2d by nCkday of L, 20by�
17 rr\ lDa t who is
his pallersonally known to me p e �ST� �, who is personown to
or who has produced 5 Gs me or who has ro u ID. ,
Signature of N tary � � — � _ Signature".try
C ERYL A HOTTENSMITH �� F '' CHERYL A HOENSMITH
•'c MY COMMISSION # 00090400 MY COMMISSION # GQ090400
Revised 04/15/1 EXPIRES Aprll 04,2021 EXPIRES April 04,2021