HomeMy WebLinkAboutCANCELLATION OF PERMITPLANNING & DEVELOPMENT 4R- KEW IE
2300 VIRGINIA AVE MAY 2 3 2019
FORT PIERCE, FL 34982
(772)462-1553 FAX462_1578 Permitting Department
St. Lucie County, FL
CHANGE OF CONTRACTOR. SUBCONTRACTOR OR CANCELLATION OF PERTMT
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 List be submitted prior to
commencing any work. There is a $50.06 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. ra
V 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: Tf 51 1 2-0(7 PermitNuntber: 1901-0020
Site Address: _ 2632 Conifer Drive, Fort Pierce
State License SLC License
Original GC, subcontractor or owneribuilder
State License SLC License
New GC, subcontractor
Reason for Cancellation Plans have changed for this lot; therefore the home as permitted will not be built
The undersigned does here y agree to indemnify and hold harmless St Lucie Court , its officers, agents and. employees fror.
costs, fees or damages ansi g from any and all claims of action for any r�cancelle
son, whi h may arise as a result of this change of
conuaclor/subcontracto collation of permit. A pe nit cannot be vo Chas been performed.
SIGNATURE OF or uilder) SIGNATUR ENE OR(o ew GC. as applicable)
PRINT NAME w`O afiamar/G GHO Moada mLLC PRINTNUtE wtlliamH eNGRBKGHO Homes LLC
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
The thllnwing instrument was acknowledged before me this
� day of ;_. 20A by
72
Personally known to me
.. rn
n}'d
�g6g676
Y g, 202'c
uenNoia t
The following instrument was acknowledged before me this
)3y day of % aLf ,20a by
and�r who is Personally known to
me or wlib lus aroduhd
Rebecca DitTla
Commission # GG060876
'r Expires: January 9.2021
Bonded thru Aaron %otary