HomeMy WebLinkAboutCANCELLATION OF PERMITSCANNM C
BY
St. Lurie C®unj
PLANNING & DEVELOPMENT SERVICES RECEIVED
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE AUG 2 6 2019
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 ST. Lucie County, 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 -
Contractor.
x 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 notarized by both the owner and qualifier of record. There is no fee for
cancellation of the permit.
`s
Date: 8/14/19
Permit Number:
1508-0153
Site Address: 9000 Clubhouse Drive, Port St. Lucie, Fl 34986
John Kay State License CDC/257273 SLC License
Original GC, subcontractor or owner/builder
State License SLC License
_New GC, subcontractor
Reason for Cancellation No work performed
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 as a result of this change of
contractor/s bcontractor or cancellation of permit. A permit cannot be cancelled if work has been performed.
(Al K &
SIGNATU ON E (or owner/builder) SIGNATURE GENERAL CONTRACTOR (or new GC, as applicable)
PRINT NAME S CAWY 5- satcn90tJ PRINT NAME John Kay_____
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
1.q. day of 2011 by_S� S.
So\,Yy,o (-1 who is personally known tome
o who has produced ffW4S0AuNo% Sas ID.
8114/19
Signatu f ary Date
Stale ofFlorida, County of St. Lucie County
The following instrument was acknowledged before me this
day of 20 19 , by__
who is personally known to
me or who has produced as ID.
8/14/19
Signature of Notary Date
Revised 09/15/16 + a� HA� Y� !— E� yRl3QN'
NotaryPublic�Uvco
MAfONWEAITH OF 1AA81IACHOEWS
My COMMIsslon Expires
Jens ts, 202ti
RECEIVED
AUG 2 6 2019
ST. Lucie County, Permitting
FORTNERVE. Ff. 339112
(712) 46.1-1553 FAX 4 t2-1471t .
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HAYLEY
,11fitary Public
NGARLEO�MoVfQNELTM of MAii
My Commission pt June 13.
2026
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