HomeMy WebLinkAboutCHANGE OF CONTRACTOR - CANCELLATION OF PERMITPLEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR - Change of Contractor is to be signed'and.notarized:by the properly owner,.
and the new contractor of record for the current permit. A new permit application must also be :corripleted with new
contractor information and signature. A new Notice: of Cominencement must be. filed: it! 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.
Date: SEPTEMBER 17, 201s Permit Number'" 1808-0230
Site "Address; X
WYNNE DEVELOPEMENT CORP. State License CGC03599 SLC License
Original -GC, subcontractor or owner/builder=
State License SLC License
New "GC, "subcontractor
Reason for.Cancellation" :NOT PROCEEDING. WITH.BUILDING,OF.SLA6 .
The' undersigned does hereby agree to indemnify and hold harmless St Lucie County: -its, officers, agentsand, 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. "
= cohtracfor/subconjtaQtomr cancellation of permit. A permit'cannot be cancelled if work hgibeen performed.
SIGNATURE.OF 0. ER (or owner/builder) SIGNATURE GENE TRACTOR'(or new GC, as applicable)
PRINT NAME MAT-THEW;LYLE WYNNE_ pRINTNAME MATTHEW LYLE WYNNE .
State of Florida,.County of St. Lucie County State of Florida, County of St. Lucie County "
e following in triune was acknowledged: before me this Tthe' ollowing rostrum nt was ackn wledged before me this
MATTHEW LYLE VIJNE_ / - day of 20iEby MA-H-ME-NW-
Ll dayof T : 20 ts,by �Pn- . .
who is personally known to me" who is personally known to
�w o has.pp ucbd as ID. or who has oduced -as
• - ' : SEPTEMBER 17, 2018 , SEPTEMBER:17, 2018
signature of Notary. Date Signature of Notary Date
,�fot Notary Public State o} Florida .:
Revised 04/15/ 6JulfeNineSsi: Notary Public State of Florida
u} My Cpn' MlsI IOn GG 038942 Julie NlnasSi '
"Expires 10/16/2020
. , _ fio+p•� _ y�,ov M1Ay Commiss(on GG 038942 , ..IExpires
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