HomeMy WebLinkAboutCANCELLATION OF PERMITM W'
PLANNING & DEVELOPMENT S:
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578
:lei ` I
MAY 2 3 2019
Permitting Department
St. Lucie County, FL
CHANGE OF CONTRACTOR SUBCONTRACTOR OR CANCELLATION OF PERMIT
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 (S7,500 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-
Coetor.
ntrVCANCELLATION 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. SCANNED
BY
l 23 %/� 1812-0503 St. Lucie County
Date: Permit Number-
Site Address: 2634 Conifer Drive, Fort Pierce
License SLC License
Original GC, subcontractor or owncr/builder
State License SLC License
New GC, subcontractor
Reason for
Plans have changed for this lot; therefore the home as permitted will not be built
The undersigned dos hereby agree to indemnify and hold harmless St Lucie County, its fficers, agents and employees fror
costs, fees or dams cs arising from any and all claims of action for any reason, which nipy arise as a result of [his change of
contractor/subcontrbctor or cancellation of permit. A permit cannot be cancelled if w r • h been performed.
SIGNATURE OF . Kf�roulleribailder). SIGNAN i 'RAL , Ci R or new GC, as applicable)
PRINT N �^H atartGRBK GHG Mooaaxood LLe PRINTNAME William Handler RBK GHO Homes LLC
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The lbllyinginstrument was acknowledgLd before me this a follywing Instrument was acknowledged bclore me this
23rdlaayof Q( IC by �`fiay of RL 2011, by
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