HomeMy WebLinkAboutCANCELLATION OF PERMITPLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING DIVISIO �, i�ar *r+
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 FEB 1.5 2019
BY
PLEASE SELECT ONE OF THE FOLLOWING: .St. Lucie County
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 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.
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:
Site Address:
Original GC, subcontractor or owner/builder
PermitNumber: / 0 — 0168
License SLC License
State License SLC License
New GC, subcontractor
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents and employees from
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 ry, _ pcancellation
of permit. A permit cannot be cancelled if work has been performed.
C&e6l
SKKATURF OF OWNER (or owner/builder) SIGNATURE GENERo�lAL
�C%O�NTRRAACTO/R,'(or new GC,, as applicable)
PRINT NAME Iat PRINT NAME V A"' L '/ �Gv
/ / `/
State of Florida, County of St. Lucie County
The following instrument was acknowledged beflore. me - this
,day of vr�, 20� by A`
eN ✓OIW41t7A who is personally known to me
or who has Produced—
^ as
.-1 I
Signat re of Nouo Date
Revised 04/1 16.....„ MARIADIAZ
;e`�Y P�°�M Notary Public -State o1 Florida
®
Commission OIGG 055017
my Comm. Expires Dec 13, 2020
^�.4;; tw` Bonded throupt National Notary Assn.
State of Florida, County of St. Lucie County
The f Ilowing instrument was aclu{o lodged before me this
Jt day of /1vAe2 20 `o by U t7 P a
& t A)L) " who is personally known to
r who eed ed as
Signature of Notary Date
...;y.... , MARIA DIAZ
;'` 4t�'6 Notary Public - State o1 Florida
Commission #%G 055017
's� dt- My Comm. Expires Dec 13, 2020
•AL; k4'. Banded through National Notary Assn.