HomeMy WebLinkAboutCANCELLATION OF PERMITPLANNING & DEVELOPMENT. SERVICES
BUILDING & ZONING DIVISION
2300 VIRGINIA, AVE 84%
FORT PIERCE, FL 34982 SPY
(772) 462-1553 FAX 462-1578 t �e�Cie co
u17ty
CHANGE•OF CONTRACTOR, SUBCONTRACTOR OR CANCELLATION OF PERMT
ASE SELECT ONE OF THE FOLLOWING:
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 ($72500 if A/C Change -out). A recorded copy'must be submitted prior to
imencing 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 S50.00 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: Z b'5 Permit Number: �' U
Address: �3 Z�J , so . dt CEvi tri UL 3U sr 'r°7S �l� gL°�iC/Z
subcontractor or owner/builder
fu
GC, subcontractor
for Cancellation
Licens . ' O SLC License
License SLC License
undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from
>, fees or damages arising from any and all claims of action for any reason,. which may arise as a result of this change of
ractor/subcontractor or cancellation of permit. A permit cannot be ea 'lied if rk has been performed.
IATURE OF OWNER (or owmr/builder) SIGN TUBE GCE—i`�l-ERRAL CONTRACTOR (or new OCR, ais pplicable)
LQT NAME PRINT NAMF_ 1 #
to of Florida, County of St Lucie County
e following instrument was acknowledged before me this
_day of 20� by
who.is personally known to me
who.has produced as ID.
of Notary Date
State of Florida, County of SL Lucie County
The following i dune t was acknowledged before me this
day of 20a. by
who is personally known to
me or 1 has produced ' as ID.
Si tur Notary Date jig /
Rellised 04/15/16 Ya�•.,; GAIl2UPK0
r`?� ¢F; Notary Public - State of F]AM.
Commission a GG 229
'oErb�� My Comm. Expires Jul 4,
Bonded through National Nota