HomeMy WebLinkAboutCANCELLATION OF PERMITI�����
PLANNING -&-DEVELOPMENT SERVICES- - - -- -- -
BUILDING & ZONING DIVISION
2300 VIRGINIA AVE IV
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 FEB 115 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-
Conjractor.
I/ 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:
422 Al AW I,
Original GC, subcontractor or owner/builder
New GC, subcontractor
Reason for Cancellation
Y414
Permit Number: 1 %0%- 016 9
License SLC License
License SLC License
The undersigned does hereby agree to indemnify an0 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 cancellation of permit. A permit cannot be cancelled if work has been performed.
SIGNATURE OF OWNER (or
7o—wner/builder) SIGNATURE GENERAL /�CONTRACTOR (or new C asap livable)
PRINT NAME /I "✓/-f—� ��� ��L��� PRINT NAME ✓ 6l, -1 —
State of Florida, County of St. Lucie County
The following instrument was acknowledged before me this
day of � 20A by �
%}WV196 % O who is personally kno to me
who h
aa rods e
ignature Notary Date 1�
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Revised 09/15 6�.`4'r'MANIA DIAZ
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_, Notary PuDIIC - State of Florida
Commission OVG 055017
`7d My Comm. Expires Doe 13, 2020
`Bonded through WonalNotuyAll
State of Florida, County of St. Lucie County
The following insW ent was acknowledged before me this
L�dayof i�D . .2049by 09ALP0
who is personally known to
e or who as producedI as ID.
Signature (Notary Date )7
�,�^..,,,,• MANIA DIAZ
,, ` i Notary PODIIC - State of Florida
5 Commission I`GG 055017
-IS"11" 4 My Comm. Expires Dec 13, 2020
t 4'" Bonded through National Notary Assn.