HomeMy WebLinkAboutCANCELLATION OF PERMITSCANNM
ByLucie CounN
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PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
CHANGE OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
CHANGE OF CONTRACTOR — Change of Contractor is to be signed and notarized by the property owner,
the new contractor of record for the current permit. A new permit application must also be completed with new
tractor information. and signature. A new Notice of Commencement must be filed in the new contractor's name
job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be submitted prior to
unencing 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.
new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub -
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only -if no work has been done.
.ation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
ation of the permit.
:e: Permit Number: ��i / D rv) q
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Address: 1Q 0� S, `e r� k s Td,
-�^)C State License !C & C O (D ) a 6l SLC License
GC, subcontractor or owner/builder
License SLC License
GC, subcontractor
eason for Cancellation U l� _r1._ M A4_- I N 6- c_ +,$/J (r 6
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/subcontractor or cancellation of permit. A permit cannot be cancelle rk has been performed.
SIGNATURE OF OWNER (or owner/builder) SIGNATURE GE ``''��C((��NTRArR ( w/GC, as applicable)
PRINT NAME PRINT NAME �l/lV��
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 Date
Revised 04/15/16
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
p_X_!N_day of TTT 20by %%- 6a r`�,
P i W C who is personally known to
me or who has roduced as ID.
Signaturesof L�totary,;,
L?"cl1PlNA!UI{1RIEGIVEIVS r.
Mll' COMPISSION # GG 02202v
EXPIRES: December 16, 2020
oe°egg,•" BordedThruliotaryPublicUndeng6ters